Requisition Supplies/Materials Form

Pick-Up Service Request Form

*This service is NOT included in the monthly Recycling Fee from HBPW for residents of the City of Hannibal. Therefore, there is a cost associated with Pick-Up Services within and without the City of Hannibal*
Todays Date*

MonthDayYear
Date
Select Department:*
Residential Pick-Up*
Business Pick-Up*
Type of Pick-Up*
*Pricing for Pick-Up Services are listed in the options above*
Phone Number*
*WE WILL CALL TO SET UP A PICK-UP TIME*.
I will be paying*
Business Name (if applicable)

If this is for a Business Name, enter name of Business*
Name of Contact*

First NameLast Name
Address of Location to be Picked-Up*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Material to be Picked Up for Recycling*

CardboardPaperPaper to Shred (.50 per pound to shred)#1, #2, #5 PlasticsElectronicsNone
Material to be Picked Up for Thrift Store Resale*

Woman's ClothingMen's ClothingChildren's ClothingChildren's ToysElectronicsMisc. Items (please list in the box below)None
Please list the MISC. Items and/or any special instructions for the Driver*
NOTICE: YOU WILL RECEIVE A SERVICE/PAYMENT TICKET THAT YOU MUST SIGN. PLEASE KEEP THIS TICKET FOR LATER REFERENCE.
Should be Empty:

Pick-Up Service Request Form