Residential a Pickup
Items being recycle, up-cycle or destroyed
Appointment
*
Pickup or Drop Off Date
*
Name
*
First Name
Last Name
Company
Company Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
List of Equipment
*
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( X )
Monitor(s)
8.00
KYD
Computer and Displays
Quantity
Item subtotal:
0.00
KYD
Computer(s)
8.00
KYD
Desktops and Laptops
Quantity
Item subtotal:
0.00
KYD
Mobile Phones
8.00
KYD
Quantity
Item subtotal:
0.00
KYD
Upstairs Equipment Removal
25.00
KYD
If Equipment has to be removed from upstairs
Quantity
1
2
3
4
5
6
7
8
9
10
Printer
10.00
KYD
Quantity
Data Destruction
12.50
KYD
On-Site Degaussing and Data Destruction
Quantity
TV Display 30-45"
45.00
KYD
Quantity
1
2
3
4
5
6
7
8
9
10
TV Display 50-65
65.00
KYD
TV Display
Quantity
1
2
3
4
5
6
7
8
9
10
TV Display 70-85
85.00
KYD
TV Display
Quantity
1
2
3
4
5
6
7
8
9
10
TV Display 90-UP
125.00
KYD
TV Display
Quantity
1
2
3
4
5
6
7
8
9
10
Subtotal
0.00
KYD
Shipping
0.00
KYD
Total
0.00
KYD
Special instructions
0/250
Signature
*
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