State Surplus - Agency Pick Up Request Form

This form is used by agencies in Shawnee County to submit a request of pick up for items destined to go to State Surplus.
Please enter the physical street address for the pick up of property.
Please enter your First Name and Last Name in this field.
Please enter the phone number where we may be able to reach you to schedule the pick up of your property. Please enter your phone number as (xxx) xxx-xxxx.
Please enter the date (MM/DD/YYYY) that you request the property to be picked up by.
Please select the type of property you have that needs to be picked up. You may select more than one option as needed.







Do you have employees that can assist with loading the property? Please indicate Yes or No.

Do you have a loading dock with easy access for property loading? Please indicate Yes or No.

Please enter the location of the property in your building. For example: Landon, 8th Floor, South end, Room 855. (Max. limit of 50 characters)
Will the property be packed for pick up? Please indicate Yes or No.

Will the property be palletized for pick up? Please indicate Yes or No.

Does the pick up require special equipment for moving? For example: Pallet jack, fork lift etc. Please indicate Yes or No.

Please enter the following information for each type of item you have for pick up: Description, Quantity, and Estimated Weight. This field is a free text field.
Please use this field to provide any additional information that you feel would be helpful for us to know about your property or pick up. This is a free text field. Thank you. (Optional field)