Template Test EN

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Step 1 of 4 – Country Selection

25%

Please begin your recycling journey by selecting and inputting required details below. Please ensure that you are only returning one item per collection request.

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Customer ID

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Customer ID

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Item 1

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Logistic Service

Delivery

Pickup

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Business Type

WEEE

Batteries

Waste Stream*

Lamps

Small IT

Monitors and Screens

Small Equipment

Large Equipment

Temperature Exchangers

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Quantity (units)

Please enter a number from 1 to 30.

Item model*

Total weight (in kg)*

Please enter a number less than or equal to 100.

Purchase ID Number of the New Item*

Invoice Upload

Accepted file types: pdf, png, jpg, jpeg, docx, Max. file size: 32 MB.

Accepted formats: PDF, PNG, JPG, JPEG, DOCX

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Item Serial Number

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Container Model

200l drum

200l drum + vermiculite

10 m3 container

2 m3 container

20 m3 container

5 m3 container

600l ASP

600l ASP + vermiculite

Cardboard box

Euro Pallet

Paloxes

Paloxes + vermiculite

Vermiculite bags

None

60l drum

60l drum + vermiculite

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Do you need proof of IT asset disposal?

Yes

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Do you need packaging service?

Yes

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Desired Date of Service

MM slash DD slash YYYY

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High Priority?

Yes

Item – Additional information

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Item 2

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Logistic Service

Delivery

Pickup

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Business Type

WEEE

Batteries

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Waste Stream

Alkaline Batteries

Li-ion batteries

NiCd

NiMH

E-scooter Loose parts

Full Scooter without Battery

Lamps

Large Equipments

Monitors and Screens

Small Equipments

Small IT

Temperature Exchangers

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Quantity (units)

Please enter a number from 1 to 30.

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Total weight (in kg)

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Item model

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Item Serial Number

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Purchase ID Number

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Container Model

200l drum

200l drum + vermiculite

10 m3 container

2 m3 container

20 m3 container

5 m3 container

600l ASP

600l ASP + vermiculite

Cardboard box

Euro Pallet

Paloxes

Paloxes + vermiculite

Vermiculite bags

None

60l drum

60l drum + vermiculite

This field is hidden when viewing the form

Do you need proof of IT asset disposal?

Yes

This field is hidden when viewing the form

Do you need packaging service?

Yes

This field is hidden when viewing the form

Invoice Upload

Max. file size: 32 MB.

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Desired Date of Service

MM slash DD slash YYYY

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High Priority?

Yes

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Item – Additional information

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Item 3

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Logistic Service

Delivery

Pickup

This field is hidden when viewing the form

Business Type

WEEE

Batteries

This field is hidden when viewing the form

Waste Stream

Alkaline Batteries

Li-ion batteries

NiCd

NiMH

E-scooter Loose parts

Full Scooter without Battery

Lamps

Large Equipments

Monitors and Screens

Small Equipments

Small IT

Temperature Exchangers

This field is hidden when viewing the form

Quantity (units)

Please enter a number from 1 to 30.

This field is hidden when viewing the form

Total weight (in kg)

This field is hidden when viewing the form

Item model

This field is hidden when viewing the form

Item Serial Number

This field is hidden when viewing the form

Purchase ID Number

This field is hidden when viewing the form

Container Model

200l drum

200l drum + vermiculite

10 m3 container

2 m3 container

20 m3 container

5 m3 container

600l ASP

600l ASP + vermiculite

Cardboard box

Euro Pallet

Paloxes

Paloxes + vermiculite

Vermiculite bags

None

60l drum

60l drum + vermiculite

This field is hidden when viewing the form

Do you need proof of IT asset disposal?

Yes

This field is hidden when viewing the form

Do you need packaging service?

Yes

This field is hidden when viewing the form

Invoice Upload

Max. file size: 32 MB.

This field is hidden when viewing the form

Desired Date of Service

MM slash DD slash YYYY

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High Priority?

Yes

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Item – Additional information

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Item 4

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Logistic Service

Delivery

Pickup

This field is hidden when viewing the form

Business Type

WEEE

Batteries

This field is hidden when viewing the form

Waste Stream

Alkaline Batteries

Li-ion batteries

NiCd

NiMH

E-scooter Loose parts

Full Scooter without Battery

Lamps

Large Equipments

Monitors and Screens

Small Equipments

Small IT

Temperature Exchangers

This field is hidden when viewing the form

Quantity (units)

Please enter a number from 1 to 30.

This field is hidden when viewing the form

Total weight (in kg)

This field is hidden when viewing the form

Item model

This field is hidden when viewing the form

Item Serial Number

This field is hidden when viewing the form

Purchase ID Number

This field is hidden when viewing the form

Container Model

200l drum

200l drum + vermiculite

10 m3 container

2 m3 container

20 m3 container

5 m3 container

600l ASP

600l ASP + vermiculite

Cardboard box

Euro Pallet

Paloxes

Paloxes + vermiculite

Vermiculite bags

None

60l drum

60l drum + vermiculite

This field is hidden when viewing the form

Do you need proof of IT asset disposal?

Yes

This field is hidden when viewing the form

Do you need packaging service?

Yes

This field is hidden when viewing the form

Invoice Upload

Max. file size: 32 MB.

This field is hidden when viewing the form

Desired Date of Service

MM slash DD slash YYYY

This field is hidden when viewing the form

High Priority?

Yes

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Item – Additional information

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Item 5

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Logistic Service

Delivery

Pickup

This field is hidden when viewing the form

Business Type

WEEE

Batteries

This field is hidden when viewing the form

Waste Stream

Alkaline Batteries

Li-ion batteries

NiCd

NiMH

E-scooter Loose parts

Full Scooter without Battery

Lamps

Large Equipments

Monitors and Screens

Small Equipments

Small IT

Temperature Exchangers

This field is hidden when viewing the form

Quantity (units)

Please enter a number from 1 to 30.

This field is hidden when viewing the form

Total weight (in kg)

This field is hidden when viewing the form

Item model

This field is hidden when viewing the form

Item Serial Number

This field is hidden when viewing the form

Purchase ID Number

This field is hidden when viewing the form

Container Model

200l drum

200l drum + vermiculite

10 m3 container

2 m3 container

20 m3 container

5 m3 container

600l ASP

600l ASP + vermiculite

Cardboard box

Euro Pallet

Paloxes

Paloxes + vermiculite

Vermiculite bags

None

60l drum

60l drum + vermiculite

This field is hidden when viewing the form

Do you need proof of IT asset disposal?

Yes

This field is hidden when viewing the form

Do you need packaging service?

Yes

This field is hidden when viewing the form

Invoice Upload

Max. file size: 32 MB.

This field is hidden when viewing the form

Desired Date of Service

MM slash DD slash YYYY

This field is hidden when viewing the form

High Priority?

Yes

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Item – Additional information

Instructions

1. Submit your request.

2. Request is validated by customer service. You will receive an e-mail with complete takeback.

3. Prepare the package.

4. Print and attach on the package the prepaid label received by email.

5. Bring your package to one of the drop-off points or arrange a pick-up.

1. Submit your request.

2. Request is validated by customer service. You will receive an e-mail with complete takeback.

3. Prepare the package.

4. Deliver the package to carrier that will show-up at the agreed day and time.

Contact Details

Full Name*

Contact Person Name*

Phone number*

Email*

Address

Street Address*

Floor

Zip / Postal Code*

City*

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Province

Country

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Central pick-up point

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Openning Hours

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Is the waste at the ground floor?

Yes

Does the building has a lift?*

Yes

Additional Details or Information

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Additional Details or Information2

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Additional Details or Information3

Review Submission

Country: {Country:73}
Category: {Waste Stream:116}
Description: {Item model:124}
Total Weight: {Total weight (in kg):117}
Full Name: {Full Name:41}
Contact Person Name: {Contact person name:42}
Phone Number: {Phone number:179}
Email: {Email:172}
Address: {Street Address:69}, {Floor:70}, {City:72}, {Zip / Postal Code:71}

Submission Check*

I have double checked my entries for correctness

Comments

This field is for validation purposes and should be left unchanged.