Pick Up Request Form
Requests are considered on a case by case basis. We are generally looking for higher ticket items.
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Pick-Up Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Donation type
Furniture
Appliances
Kitchen Tools
Computer
Lighting
Plumbing
Home Decor
Other
Donation Details
Item Description
Quantity
Estimate Amount ($)
1
2
3
4
5
6
7
8
9
10
Can you please provide a general description of your donations?
Please upload an image of the items you will be donating
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Additional image uploader
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Pick up day is Friday
Friday
How did you find out about our organization?
Facebook
Instagram
TV commercial
Google Search
Referral
Do you have any comments, notes, or special instructions?
Submit
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