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E-Waste Pickup Request
*Denotes required field
Enter your address

Specific information
Electronic Category*
(Maximum of 20 items including no more than 5 TVs per request)

Contact information

Review and Submit
Address :
Cross Street :
Pick Up Location :
Appointment Date :

First Name :
Last Name :
Phone :
Email :

I certify that this request is not for a commercial business.*