Junk Removal/Donation Agreement Please enable JavaScript in your browser to complete this form.Name *FirstLastPhone *Pickup Date *Pickup Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeAny Additional Pickup Addresses? *NoYes, One Additional Pickup AddressYes, Two Additional Pickup AddressesYes, More Than Two Pickup AddressesPickup Address #2Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePickup Address #3Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePlease List Additional Addresses Involved And What Will Be Picked Up At Each LocationServices To Be Performed At Residence *DonationsJunk RemovalPreparing Items For Landfill/Collection Center (Billed In Addition)Items To Be DonatedItems To Be Thrown AwayItems Needing Prepared (Bagged/Conditioned)Do You Need A Receipt From Donation Center?NoYesPhone Number Receipt Needs To Be Sent ToI understand I will be charged hourly for loading/unloading items to be disposed of or donated ($135/hour). This includes preparing items for landfill/collection centers or for donation centers. I will be charged $50+fees involved for any collection center and $100+fees involved for landfill drop off. I also understand I will be charged for dropping off donated items at a donation center as well (the charge depends on location and travel time involved - min $50). I understand if a donation center will not accept an item because of the condition I will be charged the fee for attempting to drop it off at the location and then charged the fee associated with throwing away the items at a landfill/collection center. *I understand that liquids (paints, chemicals, oil, antifreeze, gas, diesel, etc), paints (branches, leaves, old plants), debris (branches, leaves, old plants) are not accepted by our company. There is a minimum $300 cleaning fee for any bagged trash that has liquids/paint/hazardous materials and leaks in our trucks/trailers. There is a $50 fee (per bag) for any bagged items that have to be separated at time of disposal or if the bagged item rips/ruptures and needs to be rebagged. Please package and condition like items together to avoid this. *My driveway/street will accommodate a 16' box truck (overall length of 28-30' ft) with a height clearance of 12'. The grade of my driveway does not exceed a 15-degree slope. I understand failure to completely inform us of driveway conditions may result in damages to the driveway/property. *Submit Share this:TwitterFacebookLike this:Like Loading...
