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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:
Select a State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon Territory
*
ZIP:
*
CONTACT:
*
PHONE #:
FAX #:
P.O. #:
*
Submitter's Name:
*
CUSTOMER
NAME:
*
ADDRESS:
*
CITY:
*
STATE:
Select a State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon Territory
*
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:
Boxes
Buckets
Drums
Gaylords
Loose
Pallet
Number of pallets:
Product is ready for pick up on (mm/dd/yyyy):
Last date for pick up (mm/dd/yyyy):
Loading Times:
Select
12:00am
12:15am
12:30am
12:45am
1:00am
1:15am
1:30am
1:45am
2:00am
2:15am
2:30am
2:45am
3:00am
3:15am
3:30am
3:45am
4:00am
4:15am
4:30am
4:45am
5:00am
5:15am
5:30am
5:45am
6:00am
6:15am
6:30am
6:45am
7:00am
7:15am
7:30am
7:45am
8:00am
8:15am
8:30am
8:45am
9:00am
9:15am
9:30am
9:45am
10:00am
10:15am
10:30am
10:45am
11:00am
11:15am
11:30am
11:45am
12:00pm
12:15pm
12:30pm
12:45pm
1:00pm
1:15pm
1:30pm
1:45pm
2:00pm
2:15pm
2:30pm
2:45pm
3:00pm
3:15pm
3:30pm
3:45pm
4:00pm
4:15pm
4:30pm
4:45pm
5:00pm
5:15pm
5:30pm
5:45pm
6:00pm
6:15pm
6:30pm
6:45pm
7:00pm
7:15pm
7:30pm
7:45pm
8:00pm
8:15pm
8:30pm
8:45pm
9:00pm
9:15pm
9:30pm
9:45pm
10:00pm
10:15pm
10:30pm
10:45pm
11:00pm
11:15pm
11:30pm
11:45pm
11:59pm
to
Select
12:00am
12:15am
12:30am
12:45am
1:00am
1:15am
1:30am
1:45am
2:00am
2:15am
2:30am
2:45am
3:00am
3:15am
3:30am
3:45am
4:00am
4:15am
4:30am
4:45am
5:00am
5:15am
5:30am
5:45am
6:00am
6:15am
6:30am
6:45am
7:00am
7:15am
7:30am
7:45am
8:00am
8:15am
8:30am
8:45am
9:00am
9:15am
9:30am
9:45am
10:00am
10:15am
10:30am
10:45am
11:00am
11:15am
11:30am
11:45am
12:00pm
12:15pm
12:30pm
12:45pm
1:00pm
1:15pm
1:30pm
1:45pm
2:00pm
2:15pm
2:30pm
2:45pm
3:00pm
3:15pm
3:30pm
3:45pm
4:00pm
4:15pm
4:30pm
4:45pm
5:00pm
5:15pm
5:30pm
5:45pm
6:00pm
6:15pm
6:30pm
6:45pm
7:00pm
7:15pm
7:30pm
7:45pm
8:00pm
8:15pm
8:30pm
8:45pm
9:00pm
9:15pm
9:30pm
9:45pm
10:00pm
10:15pm
10:30pm
10:45pm
11:00pm
11:15pm
11:30pm
11:45pm
11:59pm
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
Copyright © 2011 Waste Management, Inc. & Brimark Consulting Group. All rights reserved. Information in this document is subject to change without notice.
Other products and companies referred to herein are trademarks or registered trademarks of their respective companies or mark holders.