ITAD Form

ITAD Form

Fill out our ITAD Asset form below to get a customized quote on retiring, recycling, or remarking your assets today!

Device Recycling

Company Information

Company Name *

Contact Name *

Company Address *

Company Address

Company Address

Address 2

Address 2

City

City

State/Province

State/Province

Zip/Postal

Zip/Postal

Device Location Different than Company Address?

Yes

No

Device Location

Device Location

Device Location

Address 2

Address 2

City

City

State/Province

State/Province

Zip/Postal

Zip/Postal

Device Information

Make

Model

Serial Number

Number of Hard Drives

Add Device Remove Device

This form allows for the submission of up to 20 devices. If recycling of more devices is required, please call (330) 800-2186 for a custom quote.

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Contact us today about leveraging technology that delivers better care to your patients. Click here to fill out our request form.

Or Give Us A Call: (330)800-2186