To have someone contact you to arrange a pickup of your equipment, please complete the form below and submit. Someone from our Asset Recovery Team will contact you.
Company Name:
Requestor's First Name:
Requestor's Last Name:
Pickup Information:
Address line 1:
Address line 2:
City:
State:
Zip:
Site Name (if different):
Site Phone:
Site Fax:
Site Contact Email:
Approximate Total: Number of Units	(unit is defined as any electronic device, i.e. printer or notebook. A monitor and a CPU are considered 2 units. Keyboards and mice are not counted as units)
	Please Select 1-20 units 21-40 units 41-100 units 101-200 units Desktop(s) Please Select 1-20 units 21-40 units 41-100 units 101-200 units Notebook(s) Please Select 1-20 units 21-40 units 41-100 units 101-200 units Monitor(s) Please Select 1-20 units 21-40 units 41-100 units 101-200 units Printer(s)
	Other (please describe):
Type of Service:
Value Recovery (potential remarket value in items) Recycling Services (no remarket value in the items)
Requested pickup date:		(pickup must be a minimum of 3 business days notice)
Equipment location:	Please Select Loading Dock Inside Room
Equipment condition:	Please Select Boxed Palletized Loose
Special Notes: