E-waste Retrieval Form Current Start Preview Complete Indicates required field Please read before filling in × Information message Please make sure of the following: This site of the inquiry form is managed and operated by our company. As our return E-mail is created only for responding to your inquiry, please do not use the information contained for other purposes. We may not be able to meet your request for a response by a specified date or in the case of urgent inquiries. Please fill out your inquiry details and your personal information. Company Name Company Address Contact Person First name Last name Contact Number E-mail Confirm your E-mail address by typing the same E-mail address below. Confirm email Materials to be collected Used Toners Drum Cartridges Assorted Parts Other… Enter other… Toner Qty Drum Cartridges Qty Assorted Parts Qty Requested Date of Retrieval (Option 1) Requested Date of Retrieval (Option 2) Special instructions (if any) Privacy Statement I represent and warrant that I have the authority to provide the information submitted in this form (including information in any attachments) to FUJIFILM Business Innovation Philippines, and I give my consent for such information to be stored, used and/or disclosed by FUJIFILM Business Innovation Philippines for the purpose of investigating and/or responding to my feedback/inquiry. I further authorize the processing of personal information, including subcontracting thereof and cross-border data transfer, in accordance with its privacy policy. In case of cross-border data transfer and subcontracting, the third party processor/controller or subcontractor shall be subject to comply with Philippine laws on Data Privacy and subject to the same obligations and liabilities as FUJIFILM Business Innovation Philippines.
