First Name *

Last Name *

Email *

Phone *

Company *

AP Email *

AP Phone

Address *

Pickup Location

Address 2

City *

State *

Zip Code *

Billing address same as pickup address *

Address *

Billing Location

Address2

City *

State *

Zip Code *

Please send pricing information

PO Number

EPA ID

Note: EPA ID needed for crushed lamp pick-ups in some states. Call for details.

Transportation Requirements

A truck with a liftgate is required to pick up the material.
There is a forklift available for loading the material onto the truck.
The material will need to be manually loaded onto the truck. Note: manpower charges may apply.
A full size tractor-trailer can fit into the loading dock.

Select all that apply

Where is the material stored in your facility?

Loading Time: 1st hour on-site included, $95 per hour thereafter There are height and length restrictions for the loading dock. Those restrictions are:

Drop Off Replacement Containers During Pick-Up 1

At your request, the driver can provide empty replacement containers to be used for future recycling pickups.

Number of Replacement Containers During Pick-Up 1

Drop Off Replacement Containers During Pick-Up 2

At your request, the driver can provide empty replacement containers to be used for future recycling pickups.

Number of Replacement Containers During Pick-Up 2

Drop Off Replacement Containers During Pick-Up 3

At your request, the driver can provide empty replacement containers to be used for future recycling pickups.

Number of Replacement Containers During Pick-Up 3

Drop Off Replacement Containers During Pick-Up 4

At your request, the driver can provide empty replacement containers to be used for future recycling pickups.

Number of Replacement Containers During Pick-Up 4

Available Loading Hours *

From

Available Loading Hours *

Drums of Crushed Lamps

Drums of Crushed Lamps

55 Gallon Drum Crushed Lamps

Qty/Weight

# of Boxes/Pails

# of Pallets

# of Drums

Other

Qty/Weight

# of Boxes/Pails

# of Pallets

# of Drums

Lamps

Lamps

Straight Fluorescent 4' or less

Straight Fluorescent 5' - 8'

Straight Fluorescent 9' - 12'

U-Bend or Circular

Compact with Ballast

Compact without Ballast

HID any watt

Shielded or Plastic Coated Tubes

Incandescent Lamps

UV Lamps

Flood/BIAX Lamps

Short Arc Lamps

Halogen Lamps

Broken Fluorescent (per lb.)

Broken HID (per lb.)

Ballasts

Ballasts

Non-PCB Ballast

Non-PCB Ballast

Special Instructions

The marked material is to be properly identified and prepared for transportation and tender in accordance with all applicable statutes, ordinances, permits, rules and regulations of the Federal, State, and Local governments in whose jurisdiction such material originates, passes through, or is tendered for delivery. I certify under penalty of perjury that the foregoing is true and correct. Do not place any extraneous material or liquids in drums. Presence of these materials with the crushed lamp waste could result in very significant upcharges or potential return of the waste to your facility. All charges are based on final counts upon receipt of waste at the processing center.

Thanks for getting in touch!

We appreciate you contacting us. We will get back in touch with you soon!

Have a great day!

Thanks for getting in touch!

We appreciate you contacting us. We will get back in touch with you soon!

Have a great day!

ITAD

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