Quote Request Form for Pallet Load Recycling

Do not use this form to request a pickup – see link below to “Order a Pickup”

Date:   (MM/DD/YYYY)   WM Rep Name or ID:
 
GENERATOR OF WASTE:   BILL TO: Same as Generator Not Same
*NAME:
*ADDRESS:
*CITY
*STATE
*ZIP:
*CONTACT:
*PHONE #:
FAX #:
P.O. #:
*Submitter's Name:
  
*NAME:
*ADDRESS:
*CITY
*STATE
*ZIP:
*CONTACT:
*PHONE #:
FAX #:
*EMAIL ADDRESS:
* Required Fields
TYPE UNIT OF
MEASURE		 QUANTITY
1 FOOT FLUORESCENT LAMP/S RECYCLING each
2 FOOT FLUORESCENT LAMP/S RECYCLING each
3 FOOT FLUORESCENT LAMP/S RECYCLING each
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.
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
Special Instructions
*Quantities on PICK-UP ORDER subject to actual count by WM LampTracker RECEIVING TECHNICIAN
Site Information: Hours Loading Dock

Please complete the Order Form and press submit


 
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