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Personal Information 
Name:
 
Address:  
Phone:  
Email: *
What type of junk do you have? 
Boxes, Clothes, Kitchenware
Couch, Chair, Recliner
Fridge, Freezer, A/C Unit
Leaves, Branches, Grass
Lumber, Plywood, 2"x4"s
Mattress/Boxspring
Metal Material
Stove, Washer, Dryer
Concrete
Drywall/plaster
Construction debris
Renovation
Asphalt
Cardboard, Newsprint, Books
Computer, Stereo, Game Console
Dresser, Cabinet, Ent. Center
Lawn Mower/Gardening Equip.
Pallet, Skid, Crate
Printer, Photocopier, Monitor
Shingles, Tile, Glass
Soil, Dirt, Sod, Concrete
Tires/Rims
TV, Console TV, Big Screen
Wood, Flooring, Carpet
Other
Note: We cannot accept hazardous materials (paint, chemicals, oils, etc.) 
Is your debris located:  
Where is your debris located?  
What size container do you need?  
If you are NOT on site, who should
we ask for?
 
How did you hear about us?  
Details 
Additional comments
(Instructions for our drivers i.e. I'll be in the back yard or
I have to leave the house by 11:15)
 
 
 
 
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