Pickup Order form for Pallet Load Recycling

Date:   (MM/DD/YYYY)   WM Rep Name or ID:
 
GENERATOR OF WASTE:   BILL TO: Same as Generator Not Same
*GENERATOR
  NAME:
*ADDRESS:
*CITY:
*STATE:
*ZIP:
*CONTACT:
*PHONE #:
FAX #:
P.O. #:
*Submitter's Name:
  
*CUSTOMER
  NAME:
*ADDRESS:
*CITY:
*STATE:
*ZIP:
*CONTACT:
*PHONE #:
FAX #:
*EMAIL ADDRESS:
I hereby authorize WM LampTracker to PICKUP the material listed for recycle in accordance with the price QUOTATION and TERMS and CONDITIONS of our contract/agreement.

* Required Fields
TYPE UNIT OF
MEASURE		 QUANTITY PICKUP & TRANSPORTATION
1 FOOT FLUORESCENT LAMP/S RECYCLING each
2 FOOT FLUORESCENT LAMP/S RECYCLING each
3 FOOT FLUORESCENT LAMP/S RECYCLING each
How is the material packaged:
Number of pallets:
Product is ready for pick up on (mm/dd/yyyy):
Last date for pick up (mm/dd/yyyy):
Loading Times:
to
Do you have a loading dock? Yes
No
Can your dock accommodate a full-size tractor-trailer? Yes
No
Will someone be available to load the truck? Yes
No
Is the site non-commercial? (school, church, residential) Yes
No



Approximate pick-up date is subject to change depending on scheduling, load times, weather, mechanical breakdowns, traffic delays, and other conditions beyond WM LampTracker control. WM LampTracker dispatcher or driver will confirm pick-up date/time prior to arrival of truck.
4 FOOT FLUORESCENT LAMP/S RECYCLING each
5 FOOT FLUORESCENT LAMP/S RECYCLING each
6 FOOT FLUORESCENT LAMP/S RECYCLING each
7 FOOT FLUORESCENT LAMP/S RECYCLING each
8 FOOT FLUORESCENT LAMP/S RECYCLING each
UTUBE FLUORESCENT LAMP/S RECYCLING each
CIRCULAR FLUORESCENT LAMP/S RECYCLING each
COMPACT FLUORESCENT LAMP/S RECYCLING each
HID MERCURY/HALIDE/SODIUM LAMP/S RECYCLING each
SHIELD/COATED/GROOVED LAMP/S RECYCLING each
INCANDESCENT LAMP/S RECYCLING each
UV/ARC/IGNITRON LAMP/S RECYCLING each
BROKEN LAMP/S RECYCLING lbs.
CRUSHED FLUORESCENT LAMP/S RECYCLING lbs.
Special Instructions:
PCB BALLAST RECYCLE/INCINERATION lbs.
NON-PCB BALLAST RECYCLE lbs.
ESCRAP RECYCLING lbs.
MERCURY DEVICE RECYCLING lbs.
LEAD ACID BATTERY RECYCLING lbs.
ALKALINE BATTERY RECYCLING lbs.
NICKEL BATTERY RECYCLING lbs.
LITHIUM BATTERY RECYCLING lbs.
MISCELLANEOUS RECYCLING
*Quantities on PICK-UP ORDER subject to actual count by WM LampTracker RECEIVING TECHNICIAN

Please complete the Order Form and press submit




 
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