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Sourcewell Member Number
Account Name
Pickup Information
Pickup Address Line 1
Pickup Address Line 2
Pickup Address City
Pickup Address State
Pickup Address ZIP
Pickup Location in Office
Pickup Frequency Option
- Select a value -
Daily Pickup
Smart or Occasional Pickup
Office Closing Time
Billing Address (if different than Pickup Address)
Billing Address Line 1
Billing Address Line 2
Billing Address City
Billing Address State
Billing Address ZIP
Contact Information
Contact First Name
Contact Last Name
Business Phone
Email Address
Reason for Request
UPS Customer Agreement
I agree to the terms outlined in the
UPS Customer Agreement
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