1. Business name:

2. Please provide your name and contact (full name please):

Phone:

Email:

3. Address:

City:

State:

Zip:

4. What types of equipment would you like us to pickup? Please provide detailed amounts of each item.:

5. Will you require Certified Data Destruction for your hard drives?:
—Please choose an option—YesNo

6. Can a large truck (26 ft long x 13.5 ft tall) drive up to your home or business?:
—Please choose an option—YesNo

7. If business, what are your hours of operation?:

8. If home or business is located in a 2 story or more building, is there access to an elevator?:
—Please choose an option—YesNo

9. Are there any special instructions for our team when arriving?:

10. Do you prefer a shipping option? yesno

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