Name: *

First Name

Last Name

Phone: *

(###)

###

####

Donor Type: *

Business/Organization

Individual

Special Event

Location Type: *

House

Apartment

Townhouse

Office Building

Other

Date: *

Please note, we prefer at least 24 hours notice if possible.

MM

DD

YYYY

Are you interested in regular pickups?

If you click "Yes" our PICK'd coordinator will be in touch to set something up.

Yes

Pick-up Preference: *

Please note, you cannot leave refundables in a public place where they could be PICK'd by someone else.

In backyard

In marked bin

Ring doorbell

Text/call upon arrival

Other

I have read and accept the PICK'd Terms & Conditions (below): *

Yes