Supply request

Supply Request Form
(Have you submitted the required Cleanup/Beautification Form yet?)

Your credit card information is requested! All bellow items (except garbage bags) must be returned, including gloves and vests. An invoice will be issued for any damaged or missing tools, and the amount will be deducted from the credit card. KHB will discard the credit card information after tools are returned.

* Indicates required field

Name *

First

Last

Credit Card Information *

MC VISA AMEX

Address *

Line 1

Line 2

City

State

Zip Code

Country

Credit Card Number *

Expiration Date and Security number *

By checking the box below you agree:
-     To use tools for a community beautification project, cleanup, improvement and/or maintenance project
-     To pick up and return tools to the KHB warehouse in a timely manner
-     To store the tools in a secure location, protected from the weather
-     To be financially responsible for any missing or damaged tools (other than normal wear and tear)

In consideration of borrowing and/or using equipment belonging to Keep Houston Beautiful, the group agrees to acknowledge Keep Houston Beautiful as a participant in any activity in which the equipment of Keep Houston Beautiful is used in any publication in which the activity is mentioned or discussed—including but not limited to company newsletters, press releases, and online social media and blog entries—in clear written form. Keep Houston Beautiful prefers that any such publication also include Keep Houston Beautiful’s logo, available for download : khb_one_shared_brand_logo.jpg

Check the box below to accept these terms. *

I agree.

Contact Person *

First

Last

Organization *

Pick-up date *

Mobile Number *

Cleanup date *

Email *

Supplies Assigned and Returned
(please indicate numerical amount of items requesting)

Trash Bags *

Waiver Forms *

Vests *

Gloves *

Orange Cones *

Litter Grabbers *

Hand Claw *

Garden Rake *

Heavy Metal Rake *

Small Hand Trowel *

Wheelbarrow *

Push Brooms *

Debris Shovel *

Long Nose Shovel *

Regular Shovel *

Square Head Shovel *

Swing Blade *

Hand Saw *

Loppers *

Pitch Fork *

24' Big Wheel Mower *

21' Small Mower *

Weedeater *

Weedeater Trim Cord *

Weedeater Oil/Gas Mix *

Goggles *

Gas Can - citizen fill up *

Long Scrappers *

Square Head Hoe *

Hedge Trimmer *

5 Gallon Cooler *

10 Gallon Cooler *

Ice Chest *

Post Hole Digger *

Tables (3) *

Ladders (2) *

First Aid Kit *

Recycling Bin *

Keep Houston Beautiful Sign *

Other/Comments *

Keep Houston Beautiful @ Environmental Service Center, 5614 Neches, 713-805-4953 or KHB office: 713-839-8855; Fax: 713-839-8880

Submit

Supply Request Form(Have you submitted the required Cleanup/Beautification Form yet?)

Supplies Assigned and Returned(please indicate numerical amount of items requesting)

Supply Request Form
(Have you submitted the required Cleanup/Beautification Form yet?)

Supplies Assigned and Returned
(please indicate numerical amount of items requesting)