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Name

Title

Your Email Address

Legal Business Name

Corporate Address

Does the billing department accept invoices and settlement statements via email?

Billing/Accounting Email Address

Billing/Accounting Phone Number

Does the Billing (Accounts Payable) department require a P.O. prior to paying invoices?

Does the accounting department accept electronic payments (ie: ACH, Wire Transfer)

I understand that if the final settlement for each shipment results in a credit (payment) to my company, payment will be issued by Global Electronic Recycling at Net 30.

I understand that if the final settlement for each shipment results in a charge, my company will receive an invoice. Payment for the invoice is due to Global Electronic Recycling Net 30 from the date of the invoice.

Name of person(s) or department(s) the certificate of recycling / destruction should be emailed to.

Email of department(s) or person(s) certificate of recycling / destruction should be emailed to. (If more than one, please list all)

Data Security Reports (Please select only one option for all data containing devices)

Hazardous Waste: There are some items that Global Electronic Recycling cannot accept, we identify these items as “Non Conforming Materials” they are considered hazardous waste. Example of these items are (but not limited to):Chemicals, liquids, oils, solvents, hazardous waste, corrosives, radiological waste, broken CRT’s, broken lamps, broken light bulbs, radioactive waste. A full list can be obtained from the EPA's website Defining Hazardous Waste: Listed, Characteristic and Mixed Radiological Wastes | Hazardous Waste | US EPA Items that are shipped to GER that are categorized as hazardous or non-conforming materials will result in a non-conformity incident that will require The Company’s cooperation to rectify, including but not limited to, fines, fees and corrective action. These items will also be returned to your company at your company’s expense, unless it is unsafe to do so, in which case your company will be billed for the appropriate recycling by a third party qualified to process hazardous waste. Electronics & Data: I hereby verify that the ownership of the above equipment has been transferred to Global Electronic Recycling, LLC for re-use/recycling and cannot be reclaimed or recalled. Global Electronic Recycling, LLC has communicated that any data contained in this equipment will be wiped in the event of reuse or physically destroyed (shredded) in the event of recycling and that all processes will be performed by Global Electronic Recycling, LLC or an approved downstream. I understand that this equipment must be deprovisioned from any inventory control and MDM systems, allowing for proper data wiping and sanitization.

Is there anything else you need us to know about your company or your recycling requirements? (optional)

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