Junk Removal Service Booking Form Name * First Name Last Name Email * Phone (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country Service Details * Please let us know what you need us to do Preferred Service Date: MM DD YYYY Preferred Time Slot: * A Timeslot is just a general selection, a team member will set a specified time with you Morning (8 AM - 12 PM) Afternoon (12 PM - 4 PM) Evening (4 PM - 8 PM) Type of Junk: (Select all that apply) Furniture Appliances Electronics Yard Waste Construction Debris General Household Junk Other Type of Junk (Please specify): Number of Items: Estimated Volume: (e.g., small, medium, large) Any Heavy or Bulky Items? Yes No If yes, please describe: Special Instructions: Is there anything we should know about access to your property? (e.g., stairs, narrow passages) Any specific requests or additional services needed? (e.g., dismantling furniture) Preferred Payment Method: Credit Card Debit Card Cash Other Payment Method (Please specify): Agreement: By submitting this form, you agree to our terms and conditions. You confirm that the items to be removed do not include hazardous materials. I agree to the terms and conditions. Thank you for your request! We will contact you to go over details and availability before the service is rendered. If you would like faster service and direct information on current openings and pricing please Contact us at (612) 422-4789 or info@newmindjunk.com
