City of London, EraseMyData, FREEGLE and SOENECS
Tech-Takeback
Pre-Registration Form

Data Protection sign up form

The City of London, EraseMyData (EMD), FREEGLE and SOENECS thank you in advance for taking part in this TECH-TAKEBACK scheme.

To comply with the Data Protection Act this questionnaire is to allow residents of and workers within the Square Mile to pre-register the Tech that you would like to be data-wiped and subsequently refurbished for a second life.

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* 1. Please state your details

Name *

Address

Address 2

City/Town

Postal Code

Email Address *

Phone Number *

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* 2. Please indicate which data erasure option you require:

For Free, with a guarantee of government certified data erasure

£5 per data bearing item to receive a Government approved Certificatate of data erasure

£10 per data bearing item to receive a Government approved Certificatate of data erasure with £5 donation going to charity

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* 3. Please indicate the type and the number of pieces of tech you will bring for data erasure and/or reuse (this will allow us to plan for workflow, if you want to bring more please do):

	number of items
Desktop PC	Desktop PC number of items menu
Laptop	Laptop number of items menu
Tablet	Tablet number of items menu
Games console	Games console number of items menu
Smart phone	Smart phone number of items menu
Mobile phone	Mobile phone number of items menu
Loose hard drive	Loose hard drive number of items menu
USB memory stick	USB memory stick number of items menu
Monitor/screen	Monitor/screen number of items menu
Cables	Cables number of items menu
Keyboard	Keyboard number of items menu
Printer cartridges	Printer cartridges number of items menu
Mouse	Mouse number of items menu

Other (please specify)

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* 4. I am bringing this tech for the purpose of Re-Use and I give permission to Tech-TakeBack to erase all the data contained on the devices (please remember in advance to copy/back-up all data you wish to keep from these devices prior to coming to the pop-up shop).

Yes, I agree

No, I don't agree

It would be helpful if you answer the following questions to enable us to deliver a service tailored to your needs in the future:

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* 5. How many new Tech Items do you normally buy annually?

1-3

4-6

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* 6. Would you consider any of the following alternatives to buying new tech?

Buying second hand

Long term leasing

Short term rental

Sharing with others

Would not consider

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* 7. How many pieces of Tech do you normally stop using annually and have no further use for?

1-3

4-6

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* 8. What do you normally do with your unwanted Tech?

put in a drawer or cupboard and forget about it

use a public recycling point for Weee (drop off small electrical bins or at HWRCs tips)

donate to a charity for recycling

sell online (e.g eBay)

sell other method (e.g via an exchange high street shop)

give away online (e.g via Freegle)

give to friend or family member

put in the bin (for landfill or incineration)

put in the recycling bin collected from home

Other (please specify)

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* 9. Please indicate the reason why you took the above actions?

I was worried about data

I kept it as a back-up

I forgot about it

I wanted to do the right thing and thought this was it

i wanted to get some money back from it

I wanted a charity to benefit from it

Other (please specify)

Thank you very much for completing this questionnaire.
We look forward to seeing you with Your Tech very soon!