Request for Pick Up Name* First Last Email* Enter Email Confirm Email Primary Phone*Alternative PhoneDate to Pick Up Machine(s)* MM slash DD slash YYYY (Pick-ups scheduled Monday - Friday only - MIN 7 DAY ADVANCE NOTICE REQUIRED)Current Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Zip/ Postal Code (Where the machine(s) are currently located.)Current Property Name* Written Permission to Enter* I will leave Written Permission to Enter with the Apartment Leasing Office I will be present at the time of the move Pet Containment* All pets (if any) will be contained Special Instructions I would like a 1-hour call ahead Is your unit located above floor/ground level?* Yes No Does your unit have access to an elevator?* Yes No Additional Comments regarding parking or gate entry?Please read and the Conditions below and check to indicate your agreement.Dry-Run Fee* I understand I will be charged a 'dry-run' fee of $35.00 if the driver is unable to gain access* Cleaning Fee* I understand it is my responsibility to clean the washer and/or dryer and agree to pay a cleaning fee of $40 in the event that I fail to clean the washer and/or dryer prior to pick up.* Remaining Days Billing* I understand I will be billed for the days remaining in my current 30-day billing cycle from the day I give notice for pick up, per the rental agreement signed.* Signature* Reset signature Signature locked. Reset to sign again PhoneThis field is for validation purposes and should be left unchanged.