Electronics Recycling Declaration Form
Please complete this form to declare the electronics you are recycling. All information should be accurate and relevant to your recycling submission.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Organization (if applicable)
Recycling Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Type of Electronics Being Recycled
*
Laptop
Desktop Computer
Tablet
Smartphone
Monitor
Printer
Other
Quantity of Each Item
*
Condition of Electronics
*
Working
Not Working
For Parts Only
Serial Numbers or Asset Tags (optional)
Declaration Statement I confirm that the information provided above is accurate and that these electronics are being submitted for responsible recycling.
*
Submit Declaration
Should be Empty: