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SCHEDULE A SCRAP PICKUP
Please provide the following contact and pickup information:
Name Title Company Client ID# NEW CUSTOMERS ONLY THERE IS NO NEED TO FILL OUT THE FOLLOWING CONTACT INFORMATION IF YOU ARE A CURRENT CUSTOMER WITH A VALID CLIENT ID#. Street Address Address (cont.) City State/Province Zip/Postal Code Country Work Phone FAX E-mail PICK UP INFORMATION Approximate Weight lbs Type Of Scrap To Be Picked Up Use the Control Button to Select Multiple Items Jewlery Grindings Filter Bags Floor Sweeps Crown & Bridge Other *Specify Below *Other Type Of Payment Requested Use the Control Button to Select Multiple Items Check Cash Gold Coins Bars Coins Account Credit Product Exchange Best Time/Date For Pickup
Name
Title
Company
Client ID#
NEW CUSTOMERS ONLY THERE IS NO NEED TO FILL OUT THE FOLLOWING CONTACT INFORMATION IF YOU ARE A CURRENT CUSTOMER WITH A VALID CLIENT ID#.
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
FAX
E-mail
PICK UP INFORMATION
Best Time/Date For Pickup
