Battery Recycling

Battery Recycling Program

BROADBAND

*Required information.

This is a security field. If you want this form being sent leave the following email field blank:

First Name *

Last Name *

Company Name *

Title *

your title in the company

Email *

your contact email

Phone *

Your contact phone number

Address *

Pick up address

City *

State/Province *

Zip/Postal Code *

Battery Model # *

Battery Quantity *

Packed *

Batteries Palletized and Shrink Wrapped?

Number of Pallets *

How many pallets are ready

Loading dock at site *

is there a loading lock on site to load the pallets

Forklift on site *

Business Hours *

Estimated Total Weight(lbs)

estimated total weight of the pallets

Shipping Information *

Use own carrier or an Alpha arranged carrier

Use your own Alpha Arranged

Pickup date *

Request a pick up date

Special Instructions

Today's Date *

Enter today's date