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E-waste registration form
Hello! Thank you for taking a moment to care about the environment!
ProEarth Ecosystem Services provides end to end waste management services. This is the e-waste drive registration form.
* Indicates required question
Email
*
Your email
Name
*
Your answer
Phone number
*
Your answer
Address (Please also add Google Map location for accuracy)
*
Your answer
What type of organisation are you?
*
Commercial Establishment Business
Hotel/Restaurant
Corporate Responsibility/CSR/Social Wing
Housing Society
Other:
Please tick on the possible dates that you would like to conduct e waste collection in your society
18th December 2021
22nd January 2022
Clear selection
Any other information you would like to share with us. (Please feel free to include past experiences, expectations and what kind of customisation you would like).
Your answer
Do you consent for our team to call/email you on the said coordinates for the e-waste drive?
Yes
No
Other:
Clear selection
Submit
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