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Pickup Request Form

Thank you for supporting CityWide Impact through donations. Please complete the form below and a member of our team will contact you regarding availability and next steps.

Contact Information

Full Name*

Phone*

Email*

Pickup Details

Pickup address*

What items need pickup?*

Approximate size/quantity of items*

Preferred pickup days/times*

Are there stairs involved?*

Do items require multiple people to lift?*

Are you ableto help load (if possible)*

Are the items from a smoke-free home?*

Do you have photos of the items?

Additional Notes*

We appreciate your willingness to give back through donations. Every item donated has the potential to make a meaningful impact in someone’s life.

© 2026 CityWide Impact. All Rights Reserved.

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