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2. First Name
3. Last Name
5. Business, School, Organization, Group Name*
7. Address
9. City
10. State
11. Zip Code
13. Phone Number*
14. Email Address*
16. # of Volunteers*
17. # of People Reached*
18. Select The Event Type/Types*

    1. Educational Fair
    2. Litter Prevention/Cleanup
    3. Adopt-A-Spot
    4. Adopt-A-Highway
    5. Adopt-A-Block
    6. Adopt-A-Campus
    7. Reduce Waste/Recycling
    8. Tradeshow
    9. Sustainability
    10. Environmental
    11. Beautification
    12. Other
19. If Other, Please Specify
21. Select The Items Needed*

    1. Garbage Bags
    2. Gloves
    3. Trash Grabbers
    4. Clear Recycle Bags
    5. Recycle Containers
    6. Promo Items/Merchandise
    7. Bug Spray
    8. Sanitizer
    9. Masks
    10. Other
22. If Promo Items OR Other, Please Specify The Items Needed
23. Please Provide The Quantity/Quantities Needed:*
25. Please Provide Date & Time To Pickup.*

    AVAILABLE PICK UP TIMES: Monday - Thursday 9am - 3pm. Orders Take 1 Week To Process From Request Date. NOTE: Supplies Will ONLY Be Held For 3 Days, Unless Notified Otherwise.

26. Do you need a KOB Representative to attend and be present at your event? If so, please provide details.
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28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

* indicates a required field