Submit Service Request Step 1 of 2 50% Name* First Email* CompanyPhone*ZIP Code* ZIP Code Desired ServiceSelect ServiceRecycling ServicesIT Asset DispositionData DestructionOn-Site ShreddingE-Waste Collection EventProduct DestructionReverse LogisticsDownstream Recycling "For E-Waste Collectors"Electronics RecyclingEquipment Destruction Types of OrganizationTypes of OrganizationBusiness ParkChurchCityCountyLibraryRetail CenterSchoolOther For-Profit OrganizationOther Non-Profit OrganizationsPrimary ObjectivePrimary ObjectiveCentralized ProcessCertificationsData SecurityLocalName ConfidentialityNo CostQuick TurnaroundReputable CompanyResponsible RecyclingSave MoneyPrimary purposePrimary ObjectiveAdvertisement or MarketingEnvironmentalFoot TrafficGreen EducationRaise FundsService to Tenants or ResidenceSecondary ObjectiveSecondary ObjectiveCentralized ProcessCertificationsData SecurityLocalName ConfidentialityNo CostQuick TurnaroundReputable CompanyResponsible RecyclingSave MoneySecondary purposeSecondary ObjectiveAdvertisement or MarketingEnvironmentalFoot TrafficGreen EducationRaise FundsService to Tenants or ResidenceHave you held an e-waste event in the past?Have you held an e-waste event in the past?YesNoHow much did you collect at your last event?How much did you collect at your last event?0 - 5,000lbs5,001 - 10,000 lbs10,001 - 20,000 lbs20,001 - 30,000 lbs+ 30,000 lbsIdeal event date in mind? Date Format: MM slash DD slash YYYY What Type of Equipment?Equipment ConditionEquipment ConditionDefectiveRecalledExisting Solution?Existing Solution?NoneIn-HouseOutsourcedOther - Please Specify in NotesWhat type of equipment is to be destroyed?Is there a preference for destruction methods?Is there a preference for destruction methods?CrushingFine ShreddingManual DismantlingNoneShreddingOther - Please specify in notes below.Options Option 1 Option 2 Option 3 Option 4 Option 5 Option 6 Option 7 Option 8 Option 9 Option 10 Option 11 Option 12 Option 13 Option 14 Computers / ServersComputers / Servers012345 - 910 - 1415 - 2425 - 4950+Televisions / MonitorsTelevisions / Monitors012345 - 910 - 1415 - 2425 - 4950+Laptops / TabletsLaptops / Tablets012345 - 910 - 1415 - 2425 - 4950+ComputersComputers012345 - 910 - 1415 - 2425 - 4950+ServersServers012345 - 910 - 1415 - 2425 - 4950+LaptopsLaptops012345 - 910 - 1415 - 2425 - 4950+TabletsTablets012345 - 910 - 1415 - 2425 - 4950+Hard DrivesHard Drives012345 - 910 - 1415 - 2425 - 4950+TapesTapes012345 - 910 - 1415 - 2425 - 4950+Copy MachinesCopy Machines012345 - 910 - 1415 - 2425 - 4950+Solid StateSolid State012345 - 910 - 1415 - 2425 - 4950+CD/DVD/FlopyCD/DVD/Flopy012345 - 910 - 1415 - 2425 - 4950+Other ItemsOther Items012345 - 910 - 1415 - 2425 - 4950+Certification RequirementsCertification RequirementsAdvanced - R2 Responsible RecyclingBasic - EPA & State LicensingHighest Standard - e-Stewards CertifiedNoneOther - Please specify in notes below.Frequency of Accumulation?Frequency of Accumulation?WeeklyMonthlyQuarterlySemi-AnnuallyAnnualSporadicOther - Please Specify in notes belowVolume?Volume?0 - 999 lbs1,000 - 4,999 lbs5,000 - 9,999 lbs10,000 - 24,999 lbs25,000 lbs or MoreDo you have a maximum shred Size?Do you have a maximum shred Size?No1 inch1/2 inch3 inches3/8 inch8 mmIs Data Destruction Required?Is Data Destruction Required?NoYesIs Asset Reporting Required?Is Asset Reporting Required?NoYesAre you interested in witnessing shredding?Are you interested in witnessing shredding?NoYesAre you interested in a video of the process?Are you interested in a video of the process?NoYesDo you Have a Formal Destruction Policy?Do you Have a Formal Destruction Policy?NoyesShipping Needs?Shipping Needs?Delivery to our FacilityPickup from your FacilityHighest Standard - e-Stewards CertifiedOther - Please specify in notes belowDo you have a Deadline for this job? Date Format: MM slash DD slash YYYY Do you have an asset inventory list? Drop files here or What is your Job Title?Number of Employees?Any Additional Information? This iframe contains the logic required to handle Ajax powered Gravity Forms.
