Pickup & Delivery Request Form

Full Name*

First NameLast Name
E-mail*
example@example.com
Phone Number*
Format: 0000-0000000.
Pickup Date/Time*

DayMonthYear
Date
Hour MinutesAM/PM Option
Delivery Date/Time*

DayMonthYear

Hour MinutesAM/PM Option
Pickup Address*
*Must Include Store Name
Drop-off Address*
*Signature Required at Delivery Location
Signature Required at Delivery/Drop-off Location to confirm receipt of items. The Haul Dept. is not liable for item condition or accuracy.
Upload Proof of Item Purchased*

Please upload a screenshot, receipt, or confirmation showing you’ve paid for the item we’re picking up. This helps us confirm that the item is ready and approved for pickup.✔️ Accepted:– Marketplace messages confirming payment– Store receipts– Order confirmations– Screenshots of payment apps (Zelle, CashApp, etc.)
Cancelof
File Upload

Cancelof
I confirm that I have read, understood, and agree to the Disclaimer, Terms & Conditions. This checked box serves as my binding agreement.
I need assemblyHaul away old itemBring item inside / Room drop-off
Should be Empty: