Pick-up form

Name *

Name

First Name

Last Name

Residential TV pick-up *

For residential TV pick-up there is a $65 cash only fee

Yes, I am aware of the $65 cash only fee

I am not scheduling a Residential pick up

Phone *

Phone

(###)

###

####

Email Address

Name of your company (if applicable)

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date *

Date

YYYY

Requested pick-up date and time? *

Requested pick-up date and time?

Hour

Minute

Second

Items you are recycling?

Are we picking up loose items or pallets?

How many?

Special Instructions

Comments