Material Pick-Up Request

All fields marked with * are required *Company Name:

*Type of Material:

*Pick-Up Address:

*City:	*State:

*Contact Name:

*Contact Phone: (555)555-5555 Ext.

*Your email:

*Container No.:	*Trailer No.:

1st Choice Pick-Up Date:	2nd Choice Pick-Up Date:
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Additional Notes:
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Williamsport • 201 Hepburn Street • Williamsport USA 17701 • (570) 323-9494 •1-800-598-5094 • Email: staiman@staimanrecycling.com
HOURS: MON - FRI 7AM-4PM

Hanover • 213 Poplar Street • P.O. Box 913 • Hanover, PA 17331 • (717) 646-0951 • 1-800-598-5094
HOURS: MON - FRI 8AM-4PM, SAT: 8AM-11:30AM • Email: staiman@staimanrecycling.com

Newberry • 445 Reighard Avenue • Newberry, PA • Phone: (570) 567-0065 • Fax: (570) 323-1090
HOURS: MON - FRI 5AM-3PM