Certified Electronics Reuse & Recycling Mail-in Request

Certified Electronics Reuse & Recycling Mail-In Request

All solutions providers are either e-Stewards and/or R2v3 Certified
General Information
Job Requester Name*

First NameLast Name
Job Requester Email*
example@example.com
Date Submitted*

MonthDayYear
Date
Preferred Mail-In Date*

MonthDayYear
Date
Job Reference Number
Unique Number
Location, Contact, and Equipment Description
Company/Organization*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Contact Person*
Name or Company/Organization Contact
Contact Person Phone*
Please enter a valid phone number.
Contact Person Email
example@example.com
Description of Equipment*
Descriptions/Quantities/Notes/etc.
Should be Empty:

Certified Electronics Reuse & Recycling Mail-In Request