E-Waste Challenge Form

E-waste Challenge Collection Form

TAKEN PART IN OUR E-WASTE CHALLENGE? READY TO SCHEDULE YOUR COLLECTION?FILL IN THE FORM BELOW AND WE'LL BE IN TOUCH WITH A COLLECTION DATE!
**NB! PLEASE MAKE SURE THE ORGANIZATION NAME CORRELATES TO THE ONE ENTERED ON THE SIGN UP FORM***
Name of contact person*

First NameLast Name
Name of company (if applicable)
Phone Number*
E-mail address*

Confirmation Email
Physical Address of Collection*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Please list the items which you would like us to collect:*
Estimated quantity of items:*
If you have images of the items or asset register files, please attach here

Browse Files
(optional) Cancelof
Additional Notes (If any)
From 1 July 2021, the Protection of Personal Information Act (POPIA) has come into full effect. The act is designed to protect how companies use, store and process your data.

At EC e-Waste Management (Pty) Ltd we commit to protect the information we collect from you and that it will only be used for the purpose intended. Under no circumstances will your personal details be made available to any organisations or third parties.

Thank you for your continued and loyal support.
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E-waste Challenge Collection Form