PICK UP REQUEST PICK UP IDENTIFICATION AND CONTACTS Collection point: Date: Adress: ZIP Code: VAT: Member-Ref: Contact name: Phone Number: E-mail: Mobile Phone: COLLECTION POINT DESCRIPTION AND CHARACTERISTICS Preferential pick up dates and times: Access description: On-site loading means yesno If yes, please indicate which: WASTE TO COLLECT - DEPOSITRÃO DEPOSITRÃO or other complete container yesno QUANTITY, TYPE AND EQUIPMENT PACKAGING Cooling Appliances Bulk items Palets Box(es) Container(s) Quantity Estimated Weight (Kg) Air Conditioning Bulk items Palets Box(es) Container(s) Quantity Estimated Weight (Kg) Cathodic Ray Tube Tvs Bulk items Palets Box(es) Container(s) Quantity Estimated Weight (Kg) Flat Pannels Bulk items Palets Box(es) Container(s) Quantity Estimated Weight (Kg) LED Lamps Bulk items Palets Box(es) Container(s) Depositrão for Lamps Quantity Estimated Weight (Kg) Fluorescent Lamps Bulk items Palets Box(es) Container(s) Depositrão for Lamps Quantity Estimated Weight (Kg) Other Lamps Bulk items Palets Box(es) Container(s) Depositrão for Lamps Quantity Estimated Weight (Kg) Large Household Appliances Bulk items Palets Box(es) Container(s) Quantity Estimated Weight (Kg) Photovoltaic Panels Bulk items Palets Box(es) Container(s) Quantity Estimated Weight (Kg) Small Aplliances Bulk items Palets Box(es) Container(s) Quantity Estimated Weight (Kg) IT Equipment Bulk items Palets Box(es) Container(s) Quantity Estimated Weight (Kg) IT Consumables Bulk items Palets Box(es) Container(s) Quantity Estimated Weight (Kg) Portable Batteries Bulk items Palets Box(es) Container(s) Depositrão for Batteries/Bring Batteries Quantity Estimated Weight (Kg) Industrial Batteries Bulk items Palets Box(es) Container(s) Depositrão for Batteries/Bring Batteries Quantity Estimated Weight (Kg) CERTIFICATION OF DESTRUCTION? YESNO IF YES, PLEASE FULFILL THE INFORMATION BELOW: COMPANY NAME: SENDING ADDRESS: OTHER COMMENTS Comments: To submit the form please confirm that you have learnt about the privacy policies. I have learnt about the Pivacy Policy and the Notice of Treatment of Equipment with Personal Data. Privacy Policy Data Containing Devices Privacy Statement
