Pole Pickup Form

This form is for pole pickup only!
REQUIRED FIELDS marked with * (For multiple choice options one choice must be marked or filled in. Form cannot be submitted unless all required fields are completed)

*  (mm/dd/yyyy)
*
*  (555-555-5555)
*

Notify me that Pole Pickup is complete by: (please mark only if you require notification)
  

Is this an External Customer Complaint? *
  

Note: If this is an External Customer Complaint, a phone call MUST be made to 866-955-6751 to expedite the pickup.

Pole Information:*

  
*
* (12 ft min per piece)

Pole Pickup Location:

*
*
*
*
*