Collection Offer Form

Please use the owner's details if different from the enquirer.
Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City Region

Poste Code
Email *
example@example.com
Phone Number *

Area Code Phone Number
Donation or Purchase?

Donation Purchase
Number of Items
Measurements
Model / Serial Numbers
Physical Description of the items. *
Images of the items

Select image file

Cancel of
Are you aware of any potential hazards with the object? (e.g. lead paint, asbestos, mercury, mould etc.)

Yes No Unsure
Is the object able to be operated, moved or played in any capacity?

Yes No Unsure
Please verify that you are human *
Should be Empty: