Collection Registration

Cartridge/Printer Brand(s)*

How many cartridges does your business use in a month?*

Do you use original or compatible cartridges?*

No. of boxes required:*

Company:*

Industry:

Name:*

Email:*

Phone:*

Fax:

Office Address*

Postal Address*

City

Pick-up details for courier:* Example: Please go to reception and ask for cartridge bag/s from (Insert Name here). Pick up times (insert timeframe here). Call (insert phone number here) if any issues.

We respect your right to privacy and understand that we have a responsibility to keep control of your personal information.

All information submitted on this form will be used for the administration of our collection programs which may include being passed on to manufacturers supporting the collections.
I do not wish to have my information passed on to the manufacturer of my printers and multifunction devices.