Tenant Pick-Up Request Form

Name *

Department *

Address *

Campus *

Phone Number *

E-mail Address *

Quantity of all items to be picked up:
CPU Monitor
Peripherals (mouse, keyboard, speakers)
Printer Scanner
Data storage devices (hard drive, zip drive, CD, etc.)
Other

Please list these details for each item being recycled (except data storage devices). Use commas to separate items:
Equipment type
Make
Model
Serial Number

Delivery considerations:
Identify any heavy or oversized items.
Identify location considerations (no elevator, etc.)

Pick-up Location (if different from Department Address):

* = required

You will be sent an email confirming pick-up time and date.