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recyclemgr
2023-06-23T17:34:31+00:00
Name
(Required)
First
Last
Address
(Required)
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
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California
Colorado
Connecticut
Delaware
District of Columbia
Florida
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Maryland
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Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Mobile Phone
(Required)
Email
(Required)
VIN
Year
(Required)
(YYYY)
Make
(Required)
Model
(Required)
Do you have the original title to the car?
(Required)
Yes
No
Does it Have a Battery?
(Required)
Yes
No
Does it have 4 tires on it?
(Required)
Yes
No
Are the tires inflated?
(Required)
Yes
No
Does it have aluminum rims?
(Required)
Yes
No
Does your vehicle have the original emissions system installed?
(Required)
Yes
No
Do you need it towed to one of our locations?
(Required)
Yes
No
Comments
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