To request a pickup, call (206) 551-5416 or complete the form below
and a representative will contact you to confirm your request.

CONTACT INFORMATION

Company

Name

Telephone i.e. (206) 555-1212

Address

City State Zip

PICKUP INFORMATION

Date Requesting Pickup i.e. Tuesday, December 1, 2005

Time Requesting Pickup i.e. 11:00 AM

Address Pickup: If address is "same as above", check box.

Address

City

Location of Pickup i.e. backyard, attic, 3 floor, etc

Items to Pickup

Comments/Special Instructions


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