Litter Patrol Hotline Request Form

Litter Patrol Hotline Request Form

Please fill out the form below and return to us by hitting the SEND button. Once the request is received, it will be forwarded to the Putnam Litter Patrol to be placed on their workorder list.
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Direct Garbage Control Line Application Form

Please fill out the form below and return it by pressing the SUBMIT button. Once the application is received, it will be sent to the Putnam Garbage Patrol to be included in their work order list.
This request is for :
Date of Request:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Address of Litter:

Street Address

Street Address Line 2

CityState

Zip Code
Closest Landmarks or Cross Streets:
Date First Seen:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Nature of Litter: (Please describe as best as you can)

Formulario de Solicitud de Línea Directa de Control de Basura

Por favor, complete elformulario a continuación y regreselo presionando el botón ENVIAR. Una vez quela solicitud sea recibida, se enviará al Patrullaje de Basura de Putnam paraque se incluya en su lista de órdenes de trabajo.
Esta solicitud es para
Fecha de solicitu

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Fecha de solicitu

Street Address

Street Address Line 2

CityState

Zip Code
Puntos de referencia o calles más cercanas:
Fecha en que se vio por primera vez:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Tipo de basura: (Por favor describe lo mejor que puedas)

Should we need additional information, please give us your | Si necesitamos información adicional, por favor danos tu
Name / Nombre

First NameLast Name
Call Back Number / Número para devolver la llamada
Please enter a valid phone number.Format: (000) 000-0000.
Email / correo electrónico

Confirmation EmailPlease re-enter your email
Should be Empty:

Direct Garbage Control Line Application Form