E-Waste Form

E-waste Collection Form

FILL IN THE FORM BELOW TO SCHEDULE A COLLECTION
Name of contact person

First NameLast Name
Name of company (if applicable)
Phone Number
Format: (000) 000-0000.
E-mail address

Confirmation Email
Physical Address of Collection

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Where did your e-waste come from?

Other
Please select ONLY IF one of the following applies to the person or company which the e-Waste is coming from:
Please select ONLY IF you require one or more of the following (For corporate & SMME only). Please note, you may be billed additionally.

Other
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)
How did you find out about us?
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 Collection Form