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Supply Pick-up Request

This form is to inform our staff of your need for supplies. Please submit at least three business days prior to a clean-up.

Supplies can be picked up from 8 am to 5 pm Monday through Friday at the Parks and Recreation Administration Building, located at 1001 Fourth St. If you are picking up safety vests, you will be asked to sign them out as well as return them within a week of your scheduled clean-up.

You may also print this form and return by mail or fax (mailing address and fax number located on bottom of printable form).

Anyone who submits a form should be aware that in accordance with the North Carolina Public Records law, found in North Carolina General Statutes Chapter 132, his or her e-mail address is considered public record.

Name of Group/Organization:*

Adopted Street:*

Name of Group Representative:*

Please provide one of the following:
Phone number
Clean-up Date:*

Anticipated Number of Participants:*

I need to pick up:*
Other Comments:

Please give us the date you plan to arrive so materials will be ready for pick-up:*

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