Service Request Form

If you would like to arrange for a pick up at your facility, please fill out the following information. A representative will get back to you to confirm your request.

Company Name:*
First Name:*
Last Name:*
Pickup Information:
Site Phone:*
Site Fax:
Site Contact Email:*
Street Address line 1:
Street Address line 2:
City:
State:
ZIP:
Site Name (if different):
Approximate Total Number of Units:
          TV/Monitors:

          Desktop Computers:

Notebooks:

Printers/Copiers:

Other (please specify):

Type of Service:     Asset Recovery (potential remarket value)

     Recycling Services (no remarket value) Requested pickupMonth

Day

Year

 

Equipment Location:

Equipment Floor:

st

nd

Equipment Condition:

Do you have an elevator on site?     Yes     No

 

Do you have a forklift on site?     Yes     NoIf you did not mark loading dock above, do you have one on site?     Yes     No Any additional information you would like to provide?
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