VERIFICATION FORM - Do Something
VERIFICATION FORM - Do Something
VERIFICATION FORM - Do Something
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<strong>VERIFICATION</strong> <strong>FORM</strong><br />
We’re so excited that you’ve decided to participate in our e-Waste Drive with Best Buy & ENERGY STAR. Consider<br />
this document your golden ticket –fill it out in order to be eligible Best Buy gift cards and the educational grants!<br />
REMEMBER! Before you take all your collected waste and this form to your local Best Buy, give them a courtesy<br />
call to let them know you’re coming. After you deliver the e-waste, send the completed form (and all additional<br />
team member forms) to: <strong>Do</strong> <strong>Something</strong> eWaste Contest, ATTN: eWaste Verification Forms, 24-32 Union Square<br />
East, 4th Floor, New York, NY 10003 or fax them to: (212) 254-2391<br />
Name: ______________________________________ Age:_________ Birthday (MM/DD/Y): ___/____/___<br />
Drive/School Name: ______________________________________<br />
Zip Code: ___________<br />
Best Buy store number and Drop-off Address:<br />
________________________________________________________<br />
Drop-off day & time: _________________________Number of Electronic Pieces Disposed: _______<br />
If you’re under the age of 18, please make sure your parent’s sign below.<br />
Parent signature:______________________________<br />
Date:_________________<br />
Printed name: ________________________________<br />
Instructions for Best Buy Employees<br />
<strong>Do</strong> <strong>Something</strong> and EPA have teamed up with Best Buy to help young people run some amazing e-Waste Drives in<br />
their local communities. To learn more, please visit www.dosomething.org/ewaste!<br />
That’s why they are here today with this form that they need you to verify. Please be kind and sign off on this form<br />
for them (they need it to win prizes and educational grants). But first a couple of parameters:<br />
1. This campaign is for e-waste that Best Buy normally collects, excluding TVs, monitors and batteries.<br />
Absolutely no other material can be accepted outside Best Buy’s normal electronics recycling process.<br />
2. Material collected from the groups should be placed in the electronics recycling gaylords and shipped per<br />
the electronics recycling SOP (http://www.bbyportal.com/sop/sop.php418)<br />
3. Sign below and confirm the number of pieces. Your signature verifies that the above rules were followed<br />
and the final number of collected electronics.<br />
Best Buy Employee Signature & Employee ID:___________________________________________________<br />
Number of Electronic Pieces: _____________________________________________________________
ADDITIONAL TEAM MEMBERS <strong>VERIFICATION</strong> <strong>FORM</strong><br />
If you’re working with a group, class, team, or anyone more than just you to make this drive happen, please fill out<br />
the form below for the rest of your group – especially if they are in any pictures of your drive.<br />
REMEMBER! Before you take all your collected waste and this form to your local Best Buy, give them a courtesy<br />
call to let them know you’re coming. Send the completed form (and all additional team member forms) to: <strong>Do</strong><br />
<strong>Something</strong> eWaste Contest, ATTN: eWaste Verification Forms, 24-32 Union Square East, 4th Floor, New York, NY<br />
10003 or fax them to: (212) 254-2391<br />
Name: ______________________________________ Age:_________ Birthday (MM/DD/Y): ___/____/___<br />
Drive/School Name: ______________________________________<br />
Zip Code: ___________<br />
Best Buy store number and Drop-off Address:<br />
________________________________________________________<br />
If you’re under the age of 18, please make sure your parent’s sign below.<br />
Parent signature:______________________________<br />
Date:_________________<br />
Printed name: ________________________________<br />
Name: ______________________________________ Age:_________ Birthday (MM/DD/Y): ___/____/___<br />
Drive/School Name: ______________________________________<br />
Zip Code: ___________<br />
Best Buy Drop-off Address: ________________________________________________________<br />
If you’re under the age of 18, please make sure your parent’s sign below.<br />
Parent signature:______________________________<br />
Date:_________________<br />
Printed name: ________________________________
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