Computer Disposal Form

NOTE: ALL AREAS WITH * NEED TO BE FILLED OUT _________________________________________________________________________________________________________________________________________

***THIS FORM IS FOR GOVERNMENT OR PRIVATE COMPANY ONLY ***

Title *

Mrs

First Name *
Last Name *

Organisation Type* Government Private Company

Company Name*

Company Address *

Pickup Directions*

Pickup Area* Brisbane Metro Outside Brisbane Metro

Please note: For Outside Brisbane Metro pick-ups have a minimum quantity and will incur a pickup charge. These items will be picked up by a transport company at the cheapest rate and brought back to Brisbane for Recycling.

Example: Minimum pick up 10 x working 17" monitors plus 10 x working complete personal computers. We will not pick up 1 item. Please email first before filling out this form to confirm your pick up and cost. Email: mail@brisbanecomputerrecyclers.com.au

Contact Information

Phone*		Ext
Mobile

Email*

Re Enter Email*

Pickup Details

Ready for Pickup Date

Pickup am pm

Please Note: Field below will only accept a saved PDF format file. No other files or formats can be uploaded. eg images, plain word documents, plain text files, virus codes, spam, advertising etc. If you have uploaded a PDF format file, no other fields below are required to be filled out, go directly to the next fields in blue “I agree to the Brisbane Computer Recyclers/ PC Disposals, Terms and Conditions of use ” field and continue on to submit.

Attach PDF format file

The following fields in yellow below are optional if an equipment list is being uploaded in PDF Format.

Pickup Information

Note: If None for pickup please put 0 in the box

Due to the overwhelming response we now will charge for the pick up of CRT monitors "TUBE MONITORS" << Click to find out more about the charges
Note: If you have a bulk lot ie: more than 10 monitors with 10 desktops and other items included we may waiver this fee for the pick up of monitors. Email contact us with your amounts or phone 32745993 monday to friday . Refer to what we collect for more info: Note: We do not take TYPEWRITERS OR DOT MATRIX PRINTERS

Monitor Quantity		15" LCD Only /	17" LCD or CRT /	19" LCD or CRT /	21" LCD or C RT/
Computer Box Quantity

Printer Quantity

Small Desktop

Large Desktop

Large Printer

No dot matrix printers or typewriters.

Server Quantity
Laptop Quantity
Accessories Quantity		Includes Keyboards, Mice, Cables, Speakers etc.
Software		Include Manufacturers Disks Books etc. Do not include copies

Other item/s for disposal. Please give brief description

Please note: An email with a validation link will be sent to the supplied email address.

Please validate in order for us to confirm that this is a genuine pick-up.

I agree to the Brisbane Computer Recyclers/ PC Disposals, Terms and Conditions of use

Please enter the text in the image to complete this form