ES Computer Recycle Drop-Off Form

Date:____________________

ES Name:__________________________________

Phone #___________________________________

Advisor Name:______________________________

Make and Model of Item	Serial Number
Example: HP – Laptop Computer	X95876003 - 008
Example: Epson Stylus Printer	CMR1204850

Check box for items dropped off without a serial number

Computers

Laptops

Monitors

Keyboards

Printers

ES Signature:___________________________________________________