Primary Contact *

First Name

Last Name

Company Registered Address

Complete if this is your first time submitting this form.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

When would you need the items removed by? *

MM

DD

YYYY

Condition of the Items *

We require the items to be dry but will consider collecting wet items if part of a larger collection. A nominal fee will be added for wet items.

Dry

Wet

Collection Address *

If there are multiple collection sites please enter the address for the site with the most items, and then put the additional addresses, postcodes and items in the special request section below.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country