Sign Up

Enter your transportation department and stores:
The transportation department for your organization is the contact person responsible for coordinating pick ups in a given area.

Associated with your transportation department will be a list of stores and zip codes. The zip codes are the areas where you are WILLING to to provide pick ups. The stores are the locations closest to those areas where a donor could drop off their items if they are too small or do not meet pick up criteria.

This form lets you submit one transportation department and ten stores. If you need to submit more transportation departments and stores, complete this form, including what you can. Then email us at signup@pickupmydonation.com, and we will send you a spreadsheet to fill out with all of your data.

Transportation Department

Please provide information about the department and designated agent responsible for scheduling donations.

Department Name*

What you call the dispatch department. (e.g. Logistics, Transportation, etc).

Contact Title*

Title of the person who manages this department (e.g. Logistics Coordinator).

Name*

First Last

Email*

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Website

Zip Codes*

Enter a comma separated lists of zip codes associated with this transportation department (e.g. 12345, 12344, 12355).

Transportation Department Stores

Please provide the store location(s) where a donor can be referred to drop off their donation in the event that it does NOT meet YOUR pick up criteria.

Store #1 Name*

Store #1 Address*

Street Address Address Line 2 City State ZIP Code

Store #1 Phone*

Store #1 Fax

Store #1 Website

Add a second store?

Yes

Store #2

Store #2 Name*

Store #2 Address*

Street Address Address Line 2 City State ZIP Code

Store #2 Phone*

Store #2 Fax

Store #2 Website

Add a third store?

Yes

Store #3

Store #3 Name*

Store #3 Address*

Street Address Address Line 2 City State ZIP Code

Store #3 Phone*

Store #3 Fax

Store #3 Website

Add a fourth store?

Yes

Store #4

Store #4 Name*

Store #4 Address*

Street Address Address Line 2 City State ZIP Code

Store #4 Phone*

Store #4 Fax

Store #4 Website

Add fifth store?

Yes

Store #5

Store #5*

Store #5 Address*

Street Address Address Line 2 City State ZIP Code

Store #5 Phone*

Store #5 Fax

Store #5 Website

Add a sixth store?

Yes

Store #6

Store #6 Name*

Store #6 Address*

Street Address Address Line 2 City State ZIP Code

Store #6 Phone*

Store #6 Fax

Store #6 Website

Add a seventh store?

Yes

Store #7

Store #7 Name*

Store #7 Address*

Street Address Address Line 2 City State ZIP Code

Store #7 Phone*

Store #7 Fax

Store #7 Website

Add an eighth store?

Yes

Store #8

Store #8 Name

Store #8 Address*

Street Address Address Line 2 City State ZIP Code

Store #8 Phone*

Store #8 Fax

Store #8 Website

Add a ninth store?

Yes

Store #9

Store #9 Name*

Store #9 Address*

Street Address Address Line 2 City State ZIP Code

Store #9 Phone*

Store #9 Fax

Store #9 Website

Add a tenth store?

Yes

Store #10

Store #10 Name*

Store #10 Address*

Street Address Address Line 2 City State ZIP Code

Store #10 Phone*

Store #10 Fax

Store #10 Website

Transportation Department

Transportation Department Stores

Store #2

Store #3

Store #4

Store #5

Store #6

Store #7

Store #8

Store #9

Store #10

Bank Draft Payment Information