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Pick-up Request
To be environmentally and fiscally responsible a minimum of 5 cartridges are required for pick-up
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Agency Name:
(eg. Baker City Purchasing)
*
Contact First Name
(eg. Sally)
*
Contact Last Name
(eg. Smith)
*
Contact Phone Number
(eg. 555-555-5555)
*
Contact Email
(eg. ssmith@bakercity.or.us)
*
Street Address
(eg. Physical Location)
*
City
*
State
*
Zip Code
Suite/Room Number
*
Office Hours
(eg. 8-5)
*
The Approx Number of Cartridges
(5 Minimum)
*
Specific Location of Cartridges
(eg. Under Front Counter)
*
Alternate Contact
*
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