Please complete the form below to request item(s) pickup. Fields marked with an asterisk (*) are required.

* Name:   * Email:
Company:   * Phone:
* Address:   * City:
* State:   * Zip:
Equipment Type Number Of Items
Monitor(s):
CPU's:
Laptop Computers:
Keyboards:
Printers:
Other Equipment:
Your Message:
* Pick Up Time: * Pick Up Date:
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