CLEAN UP DEXTER ONLINE TOOL REQUEST FORM

Please complete the form below and our office will confirm project with you.

PROJECT DATE: * / MM / DD YYYY

TOOL PICK UP ON FRIDAYS BETWEEN 8AM AND 4PM AND RETURN TOOLS ON MONDAYS BETWEEN 8AM AND 4PM
PROJECT LEADER'S NAME: * First Last
ORGANIZATION: *
MAILING ADDRESS: *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
EMAIL: *
BEST PHONE#: * - ### - ### ####
ALTERNATE #: - ### - ### ####
NUMBER OF VOLUNTEERS: *

THE NUMBER OF TRASH BAGS AND TOOLS REQUESTED SHOULD REFLECT THE SIZE OF YOUR PROJECT AREA AND THE NUMBER OF VOLUNTEERS THAT WILL BE WORKING. FOR EXAMPLE, AND ALLEY CLEAN UP WITH 10 VOLUNTEERS MAY NEED 2 SHOVELS, 3 RAKES, AND 20 TRASH BAGS.
NUMBER OF TRASH BAGS NEEDED:
NUMBER OF PAIRS OF GLOVES NEEDED:
NUMBER OF LITTER GRABBERS NEEDED:
NUMBER OF PUSH BROOMS NEEDED:
NUMBER OF FLAT SHOVELS NEEDED:
NUMBER OF LEAF RAKES NEEDED:
NUMBER OF HARD RAKES NEEDED:
NUMBER OF SAFETY VESTS NEEDED:
NUMBER OF BUCKETS NEEDED:
OTHER--SPECIFY
MO DRIVERS LICENSE OR STATE ID NUMBER: *
PLEASE REVIEW: *
I UNDERSTAND THAT I AM RESPONSIBLE FOR RETURNING ALL OF THESE TOOLS AND I WILL BE CHARGED A MINIMUM OF $30 FOR EACH TOOL NOT RETURNED.
DRAW YOUR SIGNATURE IN BOX BELOW: *

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