E-Waste Pickup

First Name *

Last Name *

Your Company *

Your Email *

Phone Number

Pickup Address *

Pickup Date *

Billing address same as pickup address *

Yes

No

Desktop

Quantity

Laptops

Laptops Quantity

LCDS

LCDS Quantity

Servers

Servers Quantity

Tablets

Tablets Quantity

Others.

Others. Quantity

Others..

Others Quantity..

Others...

Others... Quantity

Your Question *

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