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Service Delivery

Certificate of Destruction

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Teammate Name *

Widget

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Teammate Email

example@example.com

Location *

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Franchise Email

example@example.com

Customer Email

Filling this out will send a copy of this form to the customer

Opp ID

Site #

Date

Work Order #

Start Time

End Time

National Account

Driver Name

Route #

Pickup Address

City

State/Province

Postal

Franchise

Item Name

Quantity

Model/ Serial Number (If Applicable)

Item Name

Quantity

Model/ Serial Number (If Applicable)

Item Name

Quantity

Model/ Serial Number (If Applicable)

Item Name

Quantity

Model/ Serial Number (If Applicable)

Item Name

Quantity

Model/ Serial Number (If Applicable)

Item Name

Quantity

Model/ Serial Number (If Applicable)

Item Name

Quantity

Model/ Serial Number (If Applicable)

Item Name

Quantity

Model/ Serial Number (If Applicable)

Item Name

Quantity

Model/ Serial Number (If Applicable)

Signature

Authorizing Person's Name

Authorizing Person's Title

Date

Site Stamp / Manager on Duty Initials

IMPORTANT INSTRUCTIONS FOR TRUCK TEAM MEMBERS / FRANCHISE PARTNERS: "destroyed means that the items stated on this document have been destroyed and/or recycled, and will not be resold, donated or re-entered into the marketplace by the 1-800-GOT-JUNK? franchise listed above. Within seven days, you must attach a scanned copy of this document to the opportunity in PIPEline. Should you have any questions, please call 1-866-916-5865.

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