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0 � S -V . <br /> 1coc� <br /> SALES REPRESENTATIVE : Nick McGowan ' <br /> 1219 KANSAS AVENUE, MODESTO, CA 95351 <br /> TEL: 1-877424-1950 <br /> ELECTRONIC WASTE RECOVERY CENTER <br /> Instructions , <br /> Please complete the information below in reference of each shipment of electronics. <br /> Approximation is okay. Feel free to attach any supplementary data or information . Time. ! <br /> Physical addresses only, no PO Box's accepted . <br /> I Contact lnfvrmation- PI.EAE PRINT CLEARLYgate : VI2Z '_c <br /> �' y i ompany Name: ,�'�, <br /> ,�f. Contact Personas <br /> ) Address: dCr Signature <br /> City, state, ZIPNQ 61k K eD Driver's Lic. <br /> By signingr you confirm this is your personal property, that you <br /> one Number: <br /> are the original owner and they were purchased in California. <br /> Item Quantity Weight Other Items Quantity Weighty <br /> Televisions - CRT l 2 2 �" <br /> Monitor CEW <br /> Flat Screens - CEWS' 'Z ; <br /> CPU 's-Complete <br /> CPU 's-Not Complete NO PAY (� ;> <br /> Laptop (Good) <br /> Laptop (BAD)NO PAY NO PAY <br /> Tablets <br /> - Pads <br /> Printer (X Large) <br /> Printer ( Large) <br /> Printer (Medium ) <br /> Printer (Small ) <br /> Scanners <br /> Keyboard / Mice <br /> VCR <br /> Stereo / Tape / CD <br /> Copiers <br /> Fax Machines <br /> Misc. CPU Parts <br /> Microwaves <br /> Typewriters <br /> Wire/Cabling <br />