Document Destruction Authorization Form
Use this Document Destruction Authorization Form to request and authorize the secure destruction of documents. Please complete all sections to ensure proper handling.
Full Name
*
First Name
Last Name
Department or Company Name
*
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Document Type or Description
*
Number of Boxes or Items
*
Preferred Destruction Method
*
Shredding
Pulping
Incineration
Other
Requested Destruction Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Pickup or Destruction Location
*
Special Instructions (Optional)
Submit Authorization
Should be Empty: