CEAR Service Request Form
If you would like to arrange for a pick up at your facility, please fill out the following information. A representative will get back to you to confirm your request.
Company Name:
*
First Name:
*
Last Name:
*
Pickup Information:
Site Phone:
*
Site Fax:
Site Contact Email:
*
Street Address line 1:
Street Address line 2:
City:
State:
ZIP:
Site Name (if different):
Approximate Total Number of Units:
TV/Monitors:
1-15
16-30
31-100
101-200
>200
Desktop Computers:
1-15
16-30
31-100
101-200
>200
Notebooks:
1-15
16-30
31-100
101-200
>200
Printers/Copiers:
1-15
16-30
31-100
101-200
>200
Other (please specify):
1-15
16-30
31-100
101-200
>200
Type of Service:
Asset Recovery (potential remarket value)
Recycling Services (no remarket value)
Requested pickup date:
Month
January
February
March
April
May
June
July
August
September
October
November
December
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2008
2009
Equipment Location:
Loading Dock one location
Loading Dock various locations
Inside Warehouse one location
Inside Warehouse various locations
Inside Building one location
Inside Building various locations
Equipment Floor:
1
st
Floor
2
nd
Floor
Highest Floor
Equipment Condition:
Boxed
Palletized
Loose
Do you have an elevator on site?
Yes
No
Do you have a forklift on site?
Yes
No
If you did not mark loading dock above, do you have one on site?
Yes
No
Any additional information you would like to provide?
characters remaining
