Ewaste & Data Destruction

Electronics Recycling & Data Destruction Request

Request your electronics recycling and data destruction services
Company Name*
Point of Contact Name*

First NameLast Name
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Pickup Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Preferred Pickup Date

MonthDayYear
Date

Estimated Quantity of Equipment

Rows	Quantity
Desktop Computers
Laptops
Servers
HDD
SSDs
Other Storage Type
Networking Equipment
Monitors / TVs
Printers / Scanner (Desktop Size)
Floor Standing Copier / Plotter
Other Electronics

Additional Notes
Certificate of Data Destruction
Each Certificate of Destruction issued by Los Angeles E-Waste includes detailed records for every data-bearing device processed. The certificate documents the data storage type, manufacturer (brand), model number, serial number, storage capacity, destruction method, and proof of destruction, ensuring full transparency and verification of the data destruction process. Under 10 drives the cost will be $15 per hard drive. For quantities over 20 drives, the cost is $12 per drive.
Upload serial numbers spreadsheet (if available)

Cancelof
Authorization: I authorize Los Angeles E-Waste to recycle the listed electronic equipment and perform data destruction services if requested.
Authorized Name*
Signature*
Date*

MonthDayYear
Date
Should be Empty: