Preffered Date *

MM

DD

YYYY

Time *

Hour

Minute

Second

AM PM

Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

Country

(###)

###

####

ITEMS *

1–2 large furniture items (sofa + recliner)

10–15 trash bags or moving boxes

Light appliances or mattresses

Garage, attic, or shed cleanout

General household clutter