MAKE it YOURS Request Form

Contact Information

* Name of Group / Organization:
* Contact Name:
* Address:
Address (cont.):
* City, State:
* Zip Code:
* Phone:
* Email:
* City of Cleanup Location:
* Address & Scope of Cleanup:

* Property Type

This area is on private (including church or non-profit) property.
This area is on public (city, county, state, education institution) property.
I don’t know if this area is on public or private property.

* Disposal

We will provide our own trash disposal / recycling through our dumpster, trash cart, or recycling program.
We will need material collected by a waste hauler after the cleanup.