Business Pick-up Request | San Francisco, Palo Alto, Mountain View, San Jose

Protect the Environment and Your Image

The California Department of Toxic Substances (CRT Emergency Regulation) prohibits the improper disposal of obsolete computer equipment. Improper handling can result in fines and other civil penalties. In addition, it can damage your company's image.

Please fill out the "business pickup" request form and submit it over the web. We will contact you to coordinate a pick-up date and details. If you have any questions, please do not hesitate to call 415.287.0000 x102. or email to pickup@greencitizen.com

IT IS ILLEGAL to trash electronics in dumpsters and garbage cans. Please Recycle!

Business Pickup Request Form

Submit your company information below to request a business pickup along with the quantity of electronics & computers to be picked up. To qualify for a free pick-up request, a combination of over 20 TVs, PCs, LCDs, Laptops, and CRT Monitors are required.

This form is for California only.

Request Date: 09/2/2010 9:37 am

(* is required information)

Company Information:
Company Name*
Contact Name*
Contact Email*
Business Phone*	() - extension:
Business FAX	()
*Does Your Property Management Company Need A Certificate of Insurance from GreenCitizen? If yes provide information below:
Properity Manager Name
Contact
Phone Number
Contact Email

Pick-up Location:
Street Address*
City*
Zip*
Cross Street
Preferred Pick-up Hours
Preferred Pick-up Days
Parking Restrictions
Loading Dock	YES NO
Dock Hours
Dock Height Restrictions
Stairs	YES NO If yes, describe how many stairs below
Elevator	YES NO
Copier, Printer or any item over 75 lbs.	YES NO If yes, describe below

* Please be as precise as possible with your item quantities to ensure all your items will be picked up.

Computer	Qty PC	Qty Mac
Tower/Desktop
Laptop
Server

Screen	Qty	Size(s)
Monitor
TV
Flat Panel

Accessory	Qty
Keyboard
Mouse
Cable

Weights are approximate.

Peripheral	Qty	Weight
Printer
Copier
UPS/Battery Backup

Other miscellaneous items	Qty	Weight

Security Code* :

Please enter the code from the picture

business pick-up request form

Protect the Environment and Your Image