Application for the Return of WEEE

Applicant / Client:

Company: *

Address line 1: *

Address line 2: *

Country: *

Applicant’s name: *

Phone-extension: *

E-Mail: *

Details of the WEEE:

WEEE type: *

Purchase date: *

Purchased from: *

Dimensions (packed): *

Approx. weight: *

Field for messages and remarks: *

We/I hereby confirm that we/I have read and accepted the commitment to bear as applicant the costs for the return shipment of the WEEE, as well as that I/we consent to the sharing of the data submitted through this form with our recycling partners, insofar such may be necessary for the further processing of the application/request (the application form cannot be submitted, if you do not confirm, resp. tick the box). *

2 + 3 = ?Please prove that you are human by solving the equation *