Online Pickup Request Form

Online Pickup Request Form

Please complete all portions of the form for fastest service. All bold* items are required fields.

Contact Information

Client Name*
Client ID*	If you are unaware of your Client ID number, please request it from logistics@intechra.com before submitting this form.
Cost Center
Name*
Phone*
Email Address(es)*	Multiple addresses may be entered. Separate each one with a semi-colon and a space (see above). These addresses are used to send a confirmation e-mail message. Please verify them before submitting.

Reseller Information

The following fields are for resellers and as such are not required to complete the Pickup Request form.

Account Number:
PO Number:
Contact Name:
Phone Number:
E-Mail Address:

Pickup Location

Address*

City*
State*
Non US Province
Zip Or Postal Code*
Country

Asset Details

Total # of Units*
Leased Equipment
Number of Each:	PCs (approx 35 lbs. each) Laptops* (approx 12 lbs. each) Monitors (approx 40 lbs. each) Printers (approx 35 lbs. each) Servers (approx 50 lbs. each) Docking Stations (approx 20 lbs. each) Port Replicators (approx 20 lbs. each) Scanners (approx 20 lbs. each) Terminals (approx 35 lbs. each) Hubs Copiers Fax Machines Misc. (mice, power cords, keyboards) Other (provide description)

Location Details

Where is the equipment located in the buiding? (i.e. floor, room, etc., 255 chars max)
Will the freight company need a Certificate of Insurance to enter the facility?	PLEASE NOTE: Requirement of a Certificate may delay pickup 2-5 days.
Is union labor required to enter the building?
Maximum size truck location can accommodate:
Does the location have a dock?
Dock Hours of Operation:
Scheduling a specific pickup time required?
Is a lift gate needed?
Is a pallet jack available?
Is a forklift available?
Can hand carts be utilized to transport items from within building to dock/truck?
Where is the palletizing/shrink-wrapping to be done (e.g. dock, parking lot)?
Internal doorway size?
Deliver freight to:	Intechra Other:
Additional Comments: (500 chars max)

Note: Standard pickups are Monday through Friday between 8:00am and 5:00pm local time. Additional charges may apply including cancellations within 24 hours of scheduled pickup, attempted pickup fee and minimum asset fee for non-standard shipments per your organization's Contract Detail.

All activity and origin IP Addresses are recorded.
Unauthorized use of this system is prohibited.

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