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2. GIFT OF CHRISTMAS BARREL DONATIONS
4. As a representative for my place of business/ organization I am requesting DPVFD to contact me and schedule a time for a Gift of Christmas Barrel Deliver/ Pick-up as indicated below.
6. BARREL REQUEST*

   1. DELIVERY
   2. PICKUP
8. Date and Time Requested*
   Date and Time Requested Start Date

   Date and Time Requested Start Time

   —

   Date and Time Requested End Date

   Date and Time Requested End Time
9. How Many Barrels?*
   -- Select One --12345
11. Name of Business/ Organization*
12. Contact Name*
13. Contact's Title*
15. Address1*
17. City*
18. State*
19. Zip*
21. Phone Number*
23. Disclaimer
    Please note that this is a request and not a guarantee. You will be contacted by a DPVFD representative to confirm and approve your request.
Leave This Blank:


25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit Submit and Print

* indicates a required field