Household Hazardous Waste Voucher Form

First Name:
 
Last Name:
 
Contact Phone #:
Contact Email:
Street Address:
City:
 
State:
Zip Code:
 


How did you find out about this event?




 
How many households will you be representing?
 
Have you participated in an event like this before?
 



Select the types of items you will be bringing:

If you have questions about the types of hazardous waste we accept, please call us at 217.789.2255.






Please select a time you would like to sign up for on Saturday, October 17:




Select how you would like to obtain your voucher:


Will be sent to the email address you provided.

If you need another copy, call us at 217.789.2255.