Returning Equipment Form

Company Name*

Lease/RMA Number*

Email Address to receive confirmation and Bill of Lading Information*

Date of pick-up? (equipment must be ready to ship prior to this date)*

Address of pick-up*

Street Address Address Line 2 City State ZIP Code

Commercial loading dock available?*

Lift-Gate truck needed?*

Dock Hours*

Does the driver need to load the equipment?*

Address being shipped to:

Street Address Address Line 2 City State ZIP Code

Commercial loading dock available?

Life-Gate truck needed?

Dock Hours

Is the equipment packed, wrapped and palletized or does it need to be done by the shipping company?*

Total number of pallets or roll-on equipement*

Weights and Dimensions per pallet/item:*

Photos of equipment/pallets to be returned

Drop files here or

Any Hazardous Materials?

Name of contact at the pick-up location:*

First Name Last Name

Phone Number of contact at the pick-up location:*

Do the pallets/packing material need to be replaced/replenished?*