Make a Service Request

Customer information
Name: (required)
Phone:
Email: (required)
Best way to reach you:



Best time to reach you:

Commodity information
Commodity:
Quantity:
examples: “1 15 yard container”, “12 hampers”, “15 toters”, “25 beds and mattresses”
Notes or additional description (if needed):

Service information
When do you need service?
What time of day?
Notes or additional description (if needed):

Pickup information
Pickup location:
Any limitations on pickup?
example: “No loading dock”, “Materials held in basement”, “Materials loose, need to be packed”
Contact person for pickup (if different than above):
Phone:
Email:
Best time to reach contact:


 

IRN | 7 South State Street | Concord, NH  03301 | 603.229.1962 | fax 603.229.1960 | mail[at]ir-network.com

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