State Surplus - Agency Pick Up Request Form

* Indicates a required field

Pick Up Request Information

Agency List:

Address:

Please enter the physical street address for the pick up of property.

Contact Name:

Please enter your First Name and Last Name in this field.

Contact Phone Number:

Enter the phone number where we may be able to reach you to schedule the pick up of your property.

Date for Pick Up:

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. :

Computer Equipment

Cubicle Equipment

Heavy Equipment

Machinery

Office Furniture

Office Supplies

Shelving

Other

You may select more than one option as needed.

Do you have employees that can assist with loading the property?:

Do you have a loading dock with easy access for property loading?:

Location of Property in Building:

Example: Landon, 8th Floor, South end, Room 855. (Max. limit of 50 characters)

Will the property be packed for pick up?:

Will the property be palletized for pick up?:

Does the pick up require special equipment for moving? For example: Pallet jack, fork lift etc.:

Property to be picked up:

Additional Information: