Document Scanning Pickup Request

Name*

First NameLast Name
Company*
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Pickup Instructions
Scan mode*

B&WColor
Return file on USB drive*

YesNo
Print copies of the scanned file*

YesNo
Project Notes
Print Options
Date Required*

MonthDayYear
Date
Binding*

Edge bindStaple onlyLoose
Print in*

B&WColor
I need*

Full-size setsHalf-size sets
Quantity, full-size sets*
Quantity, half-size sets*
Desired Pickup Time and Date
Take my project to the team at:*

San JoseSacramento
Date & Time*

MonthDayYear
Date
Hour MinutesAM/PM Option
Should be Empty: