Full Name *

Email *

Phone *

Number Where You Can be Reached at the Pick-Up Time

Pick-Up Address

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1st Choice of Pick-Up Date Tuesday thru Saturday

Time: Between 9:00am and 4:00pm

2nd Choice of Pick-Up Date Tuesday thru Saturday

Time: Between 9:00 am and 4:00 pm

List of Items to be Picked Up

Give a List of Items to Help Us Better Plan for Your Pick-Up

Special Instructions