Pick Up Form

ezSellCenter, inc.
2812 University Avenue
Waterloo, IA 50701
866.909.3229

Contact Information
	Title	First^* (Required)	M.I.		Last^* (Required)	Suffix
Name:
	NOTE: Your name will appear on your check as depicted above.
Address Line 1:^*
Address Line 2:				Unit/Apt #:
City:^*					State:^*
Zip Code:^*			Phone:^* - -
E-mail Address:
	You must be over 18. No PO Boxes please. US addresses only.

Describe your item

Manufacturer: *

Model:

Age: *

Quantity:

Additional Information:

--Please tell us anything else you would like us to know about your item.-- max 1000 characters

Item Package Details (Important!!!)
	Length (inches)	Width (inches)	Height (inches)	Weight (pounds)
Dimensions: *
Note: Please pack your item securely in box prior to submission of this form and include the package details here. Bathroom scale works well for weighing boxes. Round UP to next inch and pound
Box details only required for one box, use multiple boxes if necessary
Fields marked with an asterisks (*) are required
By clicking "Submit Form" below you are agreeing that you have read and understand our Terms & Conditions