Please complete the form below to request item(s) pickup. Fields marked with an asterisk (*) are required.

    * Name:  

    * Email:

    Company:  

    * Phone:

    * Address:  

    * City:

    * State:  

    * Zip:

    Equipment Type

    Number Of Items

    Monitor(s):

    CPU's:

    Laptop Computers:

    Keyboards:

    Printers:

    Other Equipment:

    Your Message:

    * Pick Up Time:

    * Pick Up Date:

    captcha