Empty toner collection - pick-up request

Forms with (*) are required fields
Order address (please fill in here)
Company*:
Value added tax identification number (VAT ID):
Address extension (room, etc.):
First Name*:
Last Name*:
Postal Code/City*:
Street/Number*:
Telephone Number*:
Email*:

Pick up address (if diffrent to order address)
Company:
Value added tax identification number (VAT ID):
Address extension (room, etc.):
First Name:
Last Name:
Postal Code/City*:
Street/Number*:
Telephone Number:
Email:

BOX REPLACEMENT Please replace following waste disposal exchange container from the address above
60 Liter Not available in BeLux.	170 Liter	1 m³ big box
Quantity:	Quantity:	Quantity:

Further information:

Agreement
		The empty toner collection program will only accept empty 100% original KYOCERA toners and waste toner bottles. KYOCERA Document Solutions Belgium reserves the right to recover the cost of processing non-original KYOCERA toners, or toner cartridges for other manufacturers’ machines, and to suspend the toner collection service for partners and customers who fail to respect this condition.

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