New Recycling Intake — RepairBench Demo Shop

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Device Surrender for Recycling

Customer Details

First Name *

Last Name *

Phone

Street Address

Suburb

State

Post.

Proof of Identity

ID Document Type *

Document Number *

Expiry Date

ID Sighted & Verified

Device Details

Device Type *

Brand

Model

Serial Number

IMEI

Device Condition *

Reason for Recycling

Notes

Customer confirms all personal data has been removed / consent to secure data destruction

By signing below I surrender the above device for recycling and confirm: (1) I am the owner or have authority to surrender this device; (2) All personal data has been removed or I consent to secure data destruction; (3) I understand this action is irreversible and the device will be recycled or disposed of responsibly.

Customer agrees to the terms above *

Customer Signature

Customer Signature — confirming device surrender and agreement to terms

Sign above

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