Whirlpool

Job Type*

Re-Source Partners to pick up at my site
We will ship to Re-Source Partners

Location*

Site Name*

Pick Up Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Primary Contact

Name*

First Last

Phone*

Email*

Secondary Contact

Name

First Last

Phone

Email

PO Number/ CMA

Tracking Number

Equipment Details

Esitmated Quantity

Product Type	Quanity	Model Description

Does Equipment Have a BIOS or Hard Drive Password

Yes
No

Enter Password*

The following is required for Pickup Jobs Only

Loading Dock Available

Yes
No

Dock Number

Dock Hours*

Grade Level Door Available?

Yes
No

Tractor Trailer Accessible?

Yes
No

Liftgate Truck Required?

Yes
No

Manifest Uploads

What Floor is Equipment On?

Elevator Available

Yes
No

Is Equipment Consolidated?*

Yes
No

Is Equipment At Dock?*

Yes
No

(If No) Eqipment Location

Is Equipment on Pallets?

Yes
No

Estimated Pallet Count

Equipment Shrinkwrapped*

Yes
No

Pickup Comments

Specific Pick-up/Ship Date Requested?

Yes
No

If Yes is selected, 3rd Party Freight charges may apply

Requested Pick-up/Ship Date

Requested and Authorized By

First Last

Requested by Email Address

Portfolio/Profile

Primary Contact

Secondary Contact

Equipment Details

The following is required for Pickup Jobs Only

Recent Posts

Recent Posts

Social Media