1. Site Name

2. Other Site Name (if applicable)

3. PO/Cost Center Number

4. Scheduling Contact Name

5. Scheduling Contact Phone

6. Scheduling Contact Email

7. Alternate Contact (Day of Service)

8. Alternate Contact Phone Number

9. Alternate Contact Email

10. Address

11. Storage Address (if different)

12. Number of Items

13. Name of the Items (Mattress, Sofa, Wheelchair, Soft Plastic, etc.)

14. Where Are the Item(s) Located (Direct Pickup From Your Unit Is Available)

15. Stairs or Elevators (if necessary)

16. Where Can the Truck Park (if known)

17. Loading Dock (if applicable)

18. Business Hours, Including Weekends (if applicable)

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