Cargo Pickup Request Form
Customer Info
Full Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Address
*
Street Address
Apartment /Unit Number
City
State / Province
Postal / Zip Code
Item Type
What are we picking up?
*
Barrel
Box
Tote
Crate
Pallet
How Many Barrels?
*
How Many Boxes?
*
How Many Totes?
*
How Many Crates?
*
How Many Pallets?
*
Upload a photo of your barrel with the sender and consignee information visible in the photo.(If you’re shipping more than one barrel, a picture is required for each item.)
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Upload a photo of your box with the sender and consignee information visible in the photo. (If you’re shipping more than one box, a picture is required for each item).
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Upload a photo of your Tote with the sender and consignee information visible in the photo.(If you’re shipping more than one tote, a picture is required for each item.)
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Upload a photo of your Crate with the sender and consignee information visible in the photo. (If you’re shipping more than one crate, a picture is required for each item.)
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Upload a photo of your Pallet with the sender and consignee information visible in the photo. (If you’re shipping more than one pallet, a picture is required for each item.)
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Pickup Date
*
Pickup Time
*
Hour Minutes
AM
PM
AM/PM Option
What Level are the items on?
*
Ground/ Floor 1
Floor 2
Floor 3
Floor 4+
Pickup Instructions (If any)
Signature
*
Submit
Should be Empty: