Fill-A-Bag: Barrel Request

Barrel Information

# of Barrels: Please enter the number of barrels. *
Delivery Date: Enter the date you wish the barrel to be delivered.*
Delivery Time: Enter a suggested time frame for delivery time. (Note: Delivery times are usually between 10 and 1)*
Pick-Up-Date: Enter the date you would want the barrel picked up. NOTE: Barrels must be picked up no later than January 3 so we can get an accurate count.*
Delivery Address:*
Delivery City:*
Delivery Zip:*
Special Delivery Instructions: Please enter any special delivery instructions.
Who should driver ask for when delivering?*
Do you want donation envelopes to be delivered with the barrel(s)?
  • Yes
  • No
Do you wish to have the location of the barrel publicized to the public?*
Hours the public is welcome to drop off donations:*

Enter Your Contact Information:

Please enter the organization you are representing:
Job Title*
Confirm Email*
Additional Comments


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