Form 5

Device Recycling Form

Please fill out this form to reach us with your questions or concerns.
Full Name

First NameLast Name
Email Address
example@example.com
Phone Number
+44 XXXX XXXXXX or 0XXXX XXXXXX
Device Type
Device Description
Preferred Contact Method
Preferred Collection Date

DayMonthYear
Date
Hour MinutesAM/PM Option
Device Collection Address

Street Address

Address 2
CityState / ProvincePostcode
Recycling your old device with us will help reduce e-waste. If it can be repaired, it may be donated for reuse. If not, it will be stripped for parts or recycled responsibly. As a thank you, you’ll receive 10% off your next repair or service with NE Tech Repair.
I understand the above, and agree
Lead Source
Ticket Subject
Assigned To
Queue
Priority
Should be Empty:

Device Recycling Form