HAP Pickup Request Form Job Type* Re-Source Partners to pick up at my site We will ship to Re-Source Partners Location*Site Name*Pick Up Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Primary ContactName* First Last Phone*Email* Secondary ContactName First Last PhoneEmail PO Number/ CMATracking NumberEquipment DetailsEsitmated QuantityProduct TypeQuanityModel Description Does Equipment Have a BIOS or Hard Drive Password Yes No Enter Password*The following is required for Pickup Jobs OnlyLoading Dock Available Yes No Dock NumberDock Hours*Grade Level Door Available? Yes No Tractor Trailer Accessible? Yes No Liftgate Truck Required? Yes No Manifest UploadsAccepted file types: csv, xlsx, xlsm, xml, txt, pdf, jpeg, doc, png, xls, Max. file size: 64 MB.Manifest UploadsAccepted file types: csv, xlsx, xlsm, xml, txt, pdf, jpeg, doc, png, xls, Max. file size: 64 MB.Manifest UploadsAccepted file types: csv, xlsx, xlsm, xml, txt, pdf, jpeg, doc, png, xls, Max. file size: 64 MB.What Floor is Equipment On?Elevator Available Yes No Is Equipment Consolidated?* Yes No Is Equipment At Dock?* Yes No (If No) Eqipment LocationIs Equipment on Pallets? Yes No Estimated Pallet CountEquipment Shrinkwrapped* Yes No Pickup CommentsSpecific Pick-up/Ship Date Requested? Yes No If Yes is selected, 3rd Party Freight charges may applyRequested Pick-up/Ship DateRequested and Authorized By First Last Requested by Email Address Portfolio/ProfileHAP
