1-800-Got-Junk Intake Form

Business Name:

Location Name (if different):

Business Address:

Primary Contact Name:

Phone

Email:

Assessment Completed By:

Date

Month

Day

Year

Number of Rack'nPaks Needed:

Recommended Rack'nPak Location(s):

Storage Space Available for Collected Film:

Limited

Adequate

Extensive

Best Pick Up Day(s):

Best Pick Up Time(s):

Preferred Collection Frequency: (If helpful, please note the capacity is 30-40 pounds of film, equivalent to one gaylord full.)

Weekly

Bi-Weekly

Monthly

As Needed

If other, please state here:

What do you expect will be the biggest challenge? (Multiple Choice – select 1)

If other, please state here:

1-800-Got-Junk Intake Form + Pre Assessment Questions