TO MAKE GOOD USE OF CONCEPTS
ALREADY IN PLACE AND TO
TRANSFORM THEM INTO PRESENT
AND EVEN MORE EFFICENT ONES
IS THE ESSENCE OF THE WORD
"RECYCLE".

Generate funds for your School

REQUEST A FREE PICK-UP

Please complete this simple form to send us your Request.

CLIENT INFO
School Name *
A value is required.
Street Address *	City*
A value is required.	A value is required.
State	Zip code

Fax	Phone *
	A value is required.

CONTACT INFO
Name *
A value is required.
Phone	e-mail *
	A value is required.Invalid format.

MATERIALS TO BE COLLECTED

Computer		Monitor
Printer		Copier
Scanner		Motherboard
Memory card		Power supply
Sound Card		Video card
Fax		LCD
Other		Other

10¢ per pound of electronics* and $10 for musical instruments
*with the exception of cellphones, TV’s, monitors, batteries & hazardous materials

REQUEST PICK UP DATE

Date

9am - 11am		11am - 1pm
1pm - 3pm		3pm - 5 pm
After 5pm		Other

DESTRUCTION CERTIFICATE

Will you need a Certificate of destruction for these items?

YES

Remember: Our all Campaigns are over.
So please understand that all material pick-up or drop off will not be paid for. If you do not Agree, please press 'Cancel" button for this pick-up.

(*) Required Fields

REQUEST A FREE PICK-UP

CLIENT INFO

CONTACT INFO

MATERIALS TO BE COLLECTED

REQUEST PICK UP DATE

DESTRUCTION CERTIFICATE

Thank you for recycling! In a effort to conserve paper this form is sent electronically.

Thank you for recycling!
In a effort to conserve paper this form is sent electronically.