Reico Contact Information

An asterisk (*) indicates required information.

Sales Person Name *
Direct Office Number *   ( ) - ext.
Cell Phone ( ) -
Email *
Reico Office Location *

Estimated Date materials will be ready for pick-up *
Please try to be as accurate as possible and confirm as early in advance as the project allows.
In any event, The Loading Dock will call the Reico contact 3 days prior to the date entered to confirm the pick-up.

Pick-Up Address

Street *
City
State
Zip *
County

Donor Information

Name *
Phone
Email

Donor Mailing Address

Mailing Address is the same as pick-up address (skip the next three lines).
Street *
City
State
Zip

Items for Donation

Wall Cabinet Qty * if none, enter "0"
Base Cabinet Qty * if none, enter "0"
Countertops
Sink
Faucet
Light Fixture Qty:

Appliances:
NONE
Refrigerator
Exhaust Hood
Range
Stove Top
Microwave
Other
Other

Other Information

If you have any questions about using this form or
the materials your customer may donate, contact
Sondra Stafford
at 410-558-3625 x18.