Portland Public School District Dispenser Repair Form
The Form Below is intended for the Custodial Staff/Employees of the Portland Public School District for dispenser repairs ONLY
Contact Name
*
First Name
Last Name
Contact Email Address
*
example@example.com
School/District Site Name
*
School/District Site Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Dispensers (Please Select Appropriate Dispenser for Replacement)
prev
next
( X )
Small Paper Toweel
Enter description
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
Large Paper Towel
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
Location Area(s) of Repair/Replacement & Additional Information
Submit
Should be Empty: