:: wastebatteries.co.uk ::

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Please complete this form & hit the submit button to e-mail it to us, or print this page and send back the completed form by post to: Postal Address, Postal Roadname, Postal Town, POST CODE, and we will arrange delivery of your waste container.

Company Name

Company Address

Contact Name

Contact Position

Telephone Number

Postcode

Fax Number

Email Address

VAT Reg Number

EA Reg Number applicable for this site

Expiry Date

If applying for more than one site, please give address and contact details with EA Reg numbers for all individual sites:

--- Electronic Signature ---

I have read the FAQ's and agree with the terms & Conditions as set out by wastebatteries.co.uk.

Signed (name)

Position

Date