Collection / replacement address, contact details & other information
 
 
Business Name*
 
 
 

Primary contact name
  
First name*
 
 
Last name*
 
 
 
E-mail*
 
 
 
Mobile number*
 
 
 
 

Secondary contact name
If possible please let us know the details of a secondary person, this is back up contact information for the collection,
we'll only use this if we are unable to get hold of the primary contact.

 
Secondary contact full name
 
 
 
Secondary contact telephone number
 
 
 
 
Collection and delivery address
 
Street*
 
 
 
Town/City*
 
 
 
County
 
 
 
Post code
 
 
 
Country*
 
 
 
 
Product details
 
 
 
 
 
 
Total of FULL unopened (5L) packs
 
 
Total amount of OPENED (5L) packs. IMPORTANT: Complete the estimated litres left box.
 
 
Estimated litres left in opened (5L) packs
 
 
 
 
 
 
 
 
Total of FULL unopened (10L) packs
 
 
Total amount of OPENED (10L) packs. IMPORTANT: Complete the estimated litres left box.
 
 
Estimated litres left in opened (10L) packs
 
 
 
 
 
 
 
 
 
Total of FULL unopened (20L) packs
 
 
Total amount of OPENED (20L) packs. IMPORTANT: Complete the estimated litres left box.
 
 
Estimated litres left in opened (20L) packs
 
 
 
 
 
FOR COLLECTIONS LOCATED IN WALES ONLY. THIS IS REQUIRED INFORMATION.

Please tick the relevant statement below and provide your premises code if necessary.
  
I do not have a waste collection licence as I do not produce or store over 500kg of hazardous waste per year.
 
 
 
I have a waste collection licence (please provide premises code below)
 
 
 
This is my premises code
 
 
 
 
 
How we handle your data collected on this form:
 

The data captured on this form is being collected for the Primo Maxx II product recall and replacement only.
ICL will not use the information collected here for marketing purposes and will not share it with any third parties other than Veolia, our waste collection partners, who require the information for organising the collection of the out of specification product.


By submitting this form you accept the ICL Privacy policy 
Yes, I accept the ICL privacy policy*