General Metal Recycling Co.
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    Request Pick-Up
Person Requesting Pickup:
Date Pickup Requested:
Date:
From:
Address:
City:
Phone:
Fax:
Email:

Containers and Materials (please check in appropriate boxes)
4x4 Bins: Swap:
4x6 Bins: Delivery Only:
Roll Off Boxes: Pickup Only:
Barrels: Loose Material:

Additional Request / Comments: