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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