Online Pickup Request Form
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| Name *: | |
| Company *: | |
| Store Number : | |
| City *: | |
| State *: | |
| Number of Bales *: | |
| Do you need wire?* | Yes No |
| Are the bales*: | Inside Outside |
| Email *: | |
| Phone Number*: | |
| Cellular Phone : | |
| Special Requests : | |
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* Required fields |
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