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Request Form
Request Form
: Repair or Pickup Request
Let us know who and where you are... and what you have. Please be specific on what items you have, and reference our
Currently Accepted Item Listing
to see if we may be interested in your items. Many times we may be willing to pick up non-accepted items if they are picked up with accepted items.
It is also helpful to know whether the items are working or non-working. We prefer email contact, so please do include your email address. Drivers are sent out to your address to pick up the items in question and will return items requested for repair and return. Thanks!
1
Contact Name
*Required
2
Contact Email Address
(All correspondence through email)
*Required
3
Full Pickup Address and Phone Number
4
What days and time of day are the items available for pickup?
*Required
5
What do you wish done with the equipment?
Recycle/Disposal (FREE!)
Repair & Return (Billable Parts & Labor)
Replacement (Billable Purchase & Labor)
Donation (Billable Refurbishment Labor)
6
Specify items (Please include Serial Numbers)
*Required
Enter this validation code:
ELEHMCM
*Required
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