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Gift of Christmas Barrel Request

2. GIFT OF CHRISTMAS BARREL DONATIONS

4. As a representative for my place of business/ organization I am requesting DPVFD to contact me and schedule a time for a Gift of Christmas Barrel Deliver/ Pick-up as indicated below.

6. BARREL REQUEST*

   1. DELIVERY
   2. PICKUP

8. Date and Time Requested*
   Date and Time Requested Start Date

   Date and Time Requested Start Time

   —

   Date and Time Requested End Date

   Date and Time Requested End Time

10. Name of Business/ Organization*

11. Contact Name*

12. Contact's Title*

14. Address1*

16. City*

17. State*

18. Zip*

20. Phone Number*

22. Disclaimer
    Please note that this is a request and not a guarantee. You will be contacted by a DPVFD representative to confirm and approve your request.

    Please note that this is a request and not a guarantee. You will be contacted by a DPVFD representative to confirm and approve your request.

Leave This Blank:


24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit Submit and Print

* indicates a required field