Pickup Order form for Pallet Load Recycling

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Order Entry Date:
WM Rep Name or ID:

Customer/Billing Information:

 *Business Name:
 *Street Address:
Billing Contact:
 *Phone Number:
   Fax Number:
 *Email Address:
 PO of Reference #:

Pickup Site Information:

Pickup Location:   Same as Billing Location   Not Same
 *Business Name:
 *Street Address:
Pickup Contact:   Same as Billing Contact  Not Same
 *Phone Number:
   Fax Number:
 *Email Address:

Do ALL of the following circumstances apply for the pickup location? *  Yes    No
If the answer is No we will contact you for more information.
  • Is the site a commercial business? (not a school, church, residence, mini-storage, or construction site?
  • Is there a loading dock?
  • Is there room for a 53 foot trailer?
  • Is there a fork truck or pallet jack available on site?
  • Will all materials be packaged, palletized, shrink wrapped and in the pickup area?

Materials to Pickup:

Lamps: Enter Quantity Estimated Weight
For Shipment
• Straight tubes - 1 foot count lbs
• Straight tubes - 2 foot count lbs
• Straight tubes - 3 foot count lbs
• Straight tubes - 4 foot count lbs
• Straight tubes - 5 foot count lbs
• Straight tubes - 6 foot count lbs
• Straight tubes - 7 foot count lbs
• Straight tubes - 8 foot count lbs
• Ubent tubes count lbs
• Circular tubes count lbs
• CFLs countlbs
• HIDs (mercury, halide, sodium) count lbs
• LED lamps count lbs
• Other whole bulbs count lbs
• Incidentally broken lamps drums lbs
• Intentionally crushed lamps drums lbs
Lighting ballasts: count lbs

• Cell phones lbs
• TVs and Monitors lbs
• Tower, Desk, & Laptop computers lbs
• Servers lbs
• eScrap(printers, keyboards, mice, peripherals, wire) lbs

• Alkaline lbs
• Lead Acid lbs
• Nickel lbs
• Lithium Ion (rechargeable) lbs count
• Lithium Metal (non-rechargeable) lbs count
Mercury Devices & Equipment: lbs  
Other Items:
Special Instructions:


Materials must be segregated by type and packaged according to WM LampTracker packaging instructions. Materials must be in closed, sealed containers. Containers must be palletized and pallets shrink-wrapped. Boxes cannot overhang pallet. Large electronics can be shrink-wrapped to a pallet.

Batteries must be segregated by type in separate containers. Lead Acid, Lithium and 12 volt and greater Alkaline and Nickel batteries must have terminals taped or isolated to prevent contact with other batteries.

  • First and Last Date Available/Requested for Pickup * to *
  • Available Pickup Hours * to *

At time of pickup, all containers must be shrink wrapped to pallets or waste must be in Gaylords placed on pallets. How many 4, 8 and/or Gaylord pallets will you have for pickup?
  • 4 foot - 40" x 48" pallets * count
  • 8 foot - 40" x 96" pallets * count
  • Gaylords or Pallet Boxes * count

Estimated Total Shipment Weight lbs

Each pallet must be labeled for shipment
You will receive an e-mail with pallet labels that should be printed and affixed to each palletized shipment.

Pickup date and time is subject to change depending on weather, mechanical breakdown, traffic delays and other conditions beyond the control of WM LampTracker. Dispatcher will confirm pickup date and time prior to arrival.

Please also note in Special Instructions above if a lift gate will be required; if labor will be required for packaging, palletizing or loading; if pickup is at a limited or difficult access site such as a residence, school, church, hotel, storage unit, construction site, unstaffed site, military base or guarded site; or if the pickup involves hazardous waste that contains PCB Ballasts or Crushed Lamps.

Call 800-664-1434 or email universalwastepickup@wm.com for any assistance.

I am an authorized representative of the shipper. I understand that placing a pickup order constitutes acceptance of the WM LampTracker Terms and Conditions, Packaging Instructions, and Price Quotation and that actual counts and weights calculated at the WMLampTracker facility upon delivery are final. I authorize WM LampTracker to pickup and process the materials listed above.

If you agree with these statements, type "I AGREE" in the signature box below.
* Signature:
* Name:
* Phone Number:
* Email:

Request a Quote Order a Pickup Request Packaging Supplies Packaging Instructions Acceptable Wastes Terms and Conditions