Intake form

Name *

Email address *

What type of electronics do you want to recycle?

Please select at least one option.

Computers

Monitors

Printers

Televisions

Mobile Phones

Tablets

Laptops

Gaming Consoles

How many electronic items do you have for recycling?

What is the condition of the electronics?

Do you need assistance with transportation of the items?

What is your preferred method of contact?

Please provide your location (city and state).

Which service or services are you interested in?

Please select at least one option.

Electronic recycling

Data destruction

Commercial Pick-Up

Partner With Us

Volunteer

Additional questions or comments

Electronic Synergy Foundation