Service Request Form

Please complete the following form to make a service request as a new or existing SecurShred customer. On the below form, you'll be able to choose your requested service and provide necessary service information to us so that we may respond to you accordingly. Thank you for your interest in SecurShred!

STEP 1

New or Existing Customer

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NEW CUSTOMER [ You will be required to fill in all contact info, billing info, directions etc. ]

EXISTING CUSTOMER [ You will be required to fill in all contact info only. ]

NEXT STEP

STEP 2

Select Your Service

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SHRED [ Information Destruction ]

SCAN [ Document Imaging ]

STORE [ Record Storage ]

E-CYCLE [ Electronics Recycling ]

SHIP-N-DESTROY [ Secure Zero Contact Destruction ]

NEXT STEP

STEP 3

Select Your Shred Service Options

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CONTAINER SERVICE

Executive Console

36"H x 20"W x 15.5"D
(approx. 100 lbs.)
Equilivant to 3 standard
bankers boxes
Weight Capacity: ~100lbs

64 Gallon Tote

42"H x 23"W x 29"D
(approx. 200 lbs.)
Equilivant to 6 standard bankers boxes
Weight Capacity: ~200lbs

BOX SHREDDING

Standard Record Storage Box

12"H x 12"W x 15"L
(approx. 30 lbs.)

Large Record Storage Box

12"H x 12"W x 25"L
(approx. 55 lbs.)

HARD DRIVE AND SOLID STATE DRIVE DESTRUCTION

Hard Drive

Solid State Drive

OTHER SHREDDING [ Thumb Drive, Backup Tape, Cell/Smart Phone, Tablet, DVD, Uniform, ID Card, X-ray, Pill Bottle, Product ]

NEXT STEP

STEP 3

Select Your Scan Service Options

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RECORD STORAGE BOXES

Standard Record Storage Box

12"H x 12"W x 15"L
(approx. 30 lbs.)

Large Record Storage Box

12"H x 12"W x 25"L
(approx. 55 lbs.)

Filing Cabinet Drawer

OTHER SCAN [ larger format, shelves of files, odd-sized box, microfilm, microfiche, etc ]

NEXT STEP

STEP 3

Select Your Store Service Options

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RECORD STORAGE BOXES

Standard Record Storage Box

12"H x 12"W x 15"L
(approx. 30 lbs.)

Large Record Storage Box

12"H x 12"W x 25"L
(approx. 55 lbs.)

OTHER STORE [ Thumbdrive, external backup, etc ]

NEXT STEP

STEP 3

Select Your E-Cycle Service Options

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COMPUTERS

Desktop

Laptop

Server

MONITORS

COMPUTER LCD / OTHER FLAT SCREEN

TELEVISION FLAT SCREEN

CRT / OTHER OLDER TV

PRINTERS

Desktop Printer

Floor Workstation

HARD DRIVE AND SOLID STATE DRIVE

Hard Drive

Solid State Drive

OTHER E-CYCLE [ Backup Tape, Tablet, Cell/Smart Phone, Thumb Drive, DVD, Battery Backup, Keyboard, Mouse, Cable, Light Bulb, etc. ]

NEXT STEP

STEP 4

Contact info, billing info, directions etc.

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SERVICE LOCATION INFO

Full Name^*

Company

Address^*

City^*

State^*

Zip Code^*

E-Mail^*

Phone^*

BILLING INFO SAME AS LOCATION INFO ABOVE?

Full Name^*

Company

Address^*

City^*

State^*

Zip Code^*

E-Mail^*

Phone^*

SERVICE LOCATION NOTES / DIRECTIONS / SPECIAL INSTRUCTIONS

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