Bulk Collection Form

Name *

First Name

Last Name

Phone *

(###)

###

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Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

What type of item are you requesting for pick up? *

Kitchen Appliance

Furniture

Washer/Dryer

Large toddler toys/accessories

Other

Preferred Date *

Pick ups can only be scheduled for Thursdays.

MM

DD

YYYY