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Secure Computer Disposal and Recycling Free Services Form

Delaware Headquarters and Processing Center:

1148 Pulaski Highway Suite 215
Bear, Delaware 19701

Phone: (302) 345-0425
Fax: (206) 339-9115

Please Contact Us prior to Shipping any equipment, we must issue the shipment an internal tracking number in order to properly track the equipment through our process and send you your Certificate of Data Destruction.

Please fill out all information below: Bold Fields are Required to Process your order

First Name: Last Name:

Company Name:

Address:

City:  State:  Zip Code:

Phone Number: ext Preferred Way of Contact:

Client Type: private commercial non-profit school

Email Address:

Has the Equipment been exposed to Dangerous Chemicals or in need of Special Cleaning? yes no

Description of Equipment: