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State of California Verification

The California E-Waste Recycling Initiative is restricted to products purchased and used in the

state of California. To comply with the law, we are required to have you fill out this form.

Please provide the following contact information:

First Name
Last Name
Title (optional)
Company  (required for businesses)
 Address
City
State
Zip Code
Phone xxx-xxx-xxxx
  Quantity of Monitors or Televisions

Quantity of Computers or Laptops

Quantity of all other items

 

I hereby certify that the items listed or unlisted, accepted by RFBC, have been purchased and operated in the State of California. 

We do not sell, rent, share or distribute in anyway your personal information.
   
 

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Recycle for Breast Cancer. Copyright 2003. All rights reserved. RFBC is a recycling program that donates 100% of its profits to

support the fight against breast cancer through the recycling of electronic waste.
 

Recycle for Breast Cancer (RFBC)

PO Box 2929

San Ramon, CA 94583