Service Request

Request an electronics pickup

Submit the information below and a program representative will review the request, confirm eligibility, and contact you regarding scheduling, preparation requirements, and any applicable fees.

Pickup Request Form

Contact name *

Organization

Email address *

Phone number *

Pickup address *

City *

ZIP code *

Requester type *

Estimated quantity *

Equipment description *

Pickup access

Preferred pickup timing

Additional services

I confirm that the information provided is accurate and understand that submission does not guarantee pickup until the request is reviewed and confirmed.

A representative will follow up using the contact information provided.