The Centre for Cerebral Palsy - Mobile Phone Recycling Order Form Company

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Please fill in the form below if you'd like to recycle your mobile phone with The Cerebral Palsy Association of WA.

If you are an individual wishing to recycle your mobile phones please click here

* Required Field

Organisation

Company name: *

Industry:

Address: *

State:

Postcode:

We would like to nominate The
Cerebral Palsy Association of WA as the
beneficiary for funds raised from recycling
our mobile phones.

Contact Name

First name:

Surname:

Title:

Department:

Telephone:

Extension:

Fax:

Email: *

We would like to participate in Aussie Recycling Program at the following levels:

As a donor of our organisation's unwanted phones.
As a donor of staff's unwanted phones.
Allow a collection box in a prominent area for clients/customers.
Allow a cardboard dispenser box with satchels in a prominent area for clients/customers.

Details recorded on this form will not be disclosed or sold to any third party.

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