Section 1 of 1 in this document

Great American Clean-Up Supply Request

Thank you so much for helping to Keep Cobb Beautiful! It is very important that you please fill out this clean-up request form to help us improve our efforts to provide you with your supplies. We would love to receive before-and-after pictures of your street. Please send electronic photos to keepcobbbeautiful@cobbcounty.org. Thank you!

Coordinator Information

Name:

Organization:

Phone Number:

Email:

Clean-Up Information

Date of Event:

Street Name/Location of Area Cleaned:

Type of Clean-Up:

Neighborhood

School

Roadway

Waterway

Supply Request

(supplies will be donated based on availability and if applicable)

Trash Bags:

Disposable Gloves:

Pick-up tools (MUST be returned to KCB):

Safety Vests (MUST be returned to KCB):

Date and Time for Picking up Supplies

Please allow 3-5 business days for processing of all supply requests by KCB staff. Please call the office on the day of your scheduled pickup to ensure a KCB staff member is prepared to meet you.

Date:

Time:

Great American Clean-Up Supply Request

Coordinator Information

Address:

Clean-Up Information

Date of Event:

Type of Clean-Up:

Supply Request

Date and Time for Picking up Supplies

Date: