Your Connection to the Property

If Other, What is Your Connection to the Property?

Are You Authorized to Approve Removal of These Items?

Yes

No

Will You Be On-Site During Removal?

Yes

No

First name

Last name

Company name

Email

Phone

Can we text you regarding your pickup?

Yes

No

Street Address

Address Line 2

City

Zip Code

Property Type

If Other, Describe Property Type:

Gate/Lockbox/Door Code or Where Key is Hidden

Where are Items Located?

Will our staff be using stairs?

Yes

No

If Yes, How Many Flights of Stairs? (Enter 0 if you answered No)

Truck Parking Availability

If Other, Describe Parking:

We aim to be at location within 6 hours of booking. This is not always a possibility due to prior bookings.

First Choice for Pickup Date & Time

Month

Day

Year

Time

HoursMinutes

Second Choice for Pickup Date & Time

Month

Day

Year

Time

HoursMinutes

Single Item Pickup

Select an Item for Removal

If Selected Other, Please Write Here

Multi-Item Load

Larger Load Options Below - If you think you will need 1/4 of a truck load or more, scroll down to Large Load.

Quantities of Items Selected - if More Than 1 of Selected Item

Larger Load

Select Truck Load Size

Quantities of Items Selected for Large Load - if More Than 1 of Selected Item

Photo Upload (Up to 8 Photos - JPG, JPEG and PNG only)

Worker Safety & Regulatory Info

Does your pickup contain chemicals, oil-based paint, fuel, automotive fluids, unidentified liquids, propane or pressurized cylinders, asbestos, medical waste, explosives, roofing, rocks, dirt, concrete or asphalt.

Yes

No

Sign to Validate You Answered Truthfully to the Best of Your Ability.

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