Recycling Waiver Form printable pdf download

Recycling Waiver Form

Declaration a nd W aiver f or P ick U p o f C ustomer R ecycling

STAPLES C anada I nc.

Computers, C PU’s &

Printers a nd P eripherals

portable c omputers

□ Computers

□ Fax M achines

□ CPU’s

□ Phones

□ Laptops

□ Printers

□ C ombo T V/Computer

□ PDAs/Pagers

□ O ther D ata c ontaining

□ Cameras

□ Photocopiers

device

To recycle more than 3 tech items at a time, just email eCycle directly at

and reference the code “easy on the planet.”

I h ereby d eclare t hat t he e lectronic/computer e quipment d escribed a bove d oes n ot c ontain a ny p ersonal

information, c onfidential o r s ensitive d ata c oncerning m e o r a ny o ther p erson.

I h ereby w aive m y e ntitlement t o t ake a ny a ction, m ake a ny c laim o r i nstitute a ny l awsuit r especting t he

equipment given and where applicable respecting any personal information or confidential or sensitive

data that may be on such equipment. I hereby give STAPLES Canada Inc. full and final release pertaining

to a ny s uch c laim, a ction, l awsuit, d ebt, d emand o r o bligation o f a ny n ature w hatsoever a rising f rom t he

presence of such information or data on the equipment or from subsequent use or abuse of such

information b y a ny o ther p erson. I tems w ill n ot b e r eturned.

Please r eturn t o D river

Customer:

_______________________________

(Print n ame)

(Print c ompany n ame)

_______________________________

(Signature o f c ustomer)

Date: _ __________

5/12/14

Recycling Waiver Form