Bulk Purge Intake Form

Name *

First Name

Last Name

Phone *

(###)

###

####

On-site contact (if different)

First Name

Last Name

On-site contact's phone number (if different)

(###)

###

####

Address where the project will take place *

If there are multiple locations, please explain below

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Would you need a pre-service consultation or a site-visit?

Yes

No

Unsure

Is there an elevator available for materials located on other floors?*

Yes (*If yes, please include more information below about storage locations)

No (If selected, we may assume all materials are located ground-floor)

Estimated walking distance between materials and shredding truck:

Please include total distance inclusive of other floors if applicable

Less than 25 feet

25-50 feet

50+ feet (please specify approximate distance below)

Additional services requested

Please select all that apply and provide details below

Hard drives with serialization

Hard drives without serialization

Solid-state drives with serialization

Solid-state drives without serialization

Optical media (CD-ROM, DVD, etc.)

Magnetic media (LTO/DLT tapes, VHS tapes, floppy disks, reel-to-reel, etc.)

X-rays

Products (proprietary overstock, etc.)

Other (explain below)