Collection Request Form

To arrange a collection of assets from your site please complete the form below with as much detail as possible.

Please ensure you have read and understood the Greenbox Asset Management Agreement.

http://www.greenbox.com.au/ama

Unless specifically stated Greenbox Recytech will not check for the presence of client data, configuration information or any identification markings on items provided by the Customer. Greenbox Recyctech will therefore not provide data security and sanitisation services unless specifically agreed to. By agreeing for Greenbox Recytech to collect or receive any items, Customer acknowledges that Greenbox Recytech does not accept any responsibility for Customers data unless specifically contracted to provide data security/sanitisation services.

If an asset is locked then we will default to the Destruction process.

Our minimum collection quantity is 50 items except by prior arrangement.

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Name*

First Last

Email

Account Name*

Opportunity ID*

Opportunity ID - If you have been advised your Opportunity ID by your Account Manager, please enter it here - Format (GBO-xxxx-xxxx) Otherwise please proceed to the next question

Date - Minimum pls allow 3 days to collect dd/mm/yyyy

Requested Date of Collection : this date in not confirmed until verified by Greenbox Recytech Logistics

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PICKUP LOCATION DETAILS

The location where the equipment is to be collected

Collection Site Name*

- Enter building name or company identifier eg - Head Office, Depot 1, Sales Office Newstead, Waterfront Place

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

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ON SITE CONTACT DETAILS

ON SITE CONTACT NAME

First Last

ON SITE CONTACT Email

ON SITE CONTACT Phone

Preferred method of contact

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DETAILS OF COLLECTION

Please provide as much detailed information as requested to ensure we arrange the most cost effective method of collection.

Purchase Order # :

Pickup Reference # :

How many Cartons/Boxes :

How many Pallets :

Approximate size and weight of each carton / pallet H x L x W)

How many Loose Computers / Desktops

How many Loose Monitors

How many Loose Laptops

How many Loose Printers / Office Devices

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EXTRA DETAILS OF COLLECTION

Please provide as much detailed information as requested to ensure we arrange the most cost effective method of collection.

Please supply any other information that may be useful to the collection of your equipment, i.e. Stairs, parking instructions, business hours etc

Required Equipment

Pallet Jack
Trolley
Forklift
Packing Boxes

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CONFIRMATIONS

Consent*

I agree

Unless specifically stated Greenbox will not check for the presence of client data, configuration information or any identification markings on items provided by Customer. Greenbox will therefore not provide data security and sanitisation services unless specifically agreed to. By agreeing for Greenbox to collect or receive any items, Customer acknowledges that Greenbox does not accept any responsibility for Customers data unless specifically contracted to provide data security/sanitisation services.

Consent*

I agree

I confirm that by submitting this Lot Request Form, I have read and agree with all of the terms of the Greenbox Asset Management Agreement. http://www.greenbox.com.au/ama

Consent*

I agree

I understand and confirm that by submitting this collection request I will incur the freight and logistics charges outlined in the relevant proposal and if there isn’t a relevant proposal then I agree to paying reasonable charges associated with the collection.

Email

This field is for validation purposes and should be left unchanged.

Collection Request Form

Lot Collection Request Form