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HTR-Group
P.O. Box 185
Lake Ozark, MO  65049		 Toll Free: 888.537.4874
Phone: 573.302.7575
Fax: 573.302.7579

PICK-UP ORDER

(REV. 01-01-07)

100% RECYCLE
All parts of the Lamp are recycled.
NOTHING IS LANDFILLED!

Website www.htr-group.com     E-mail sales@htr-group.com

Date:   (MM/DD/YYYY)    
GENERATOR OF WASTE:   BILL TO:

NAME:
ADDRESS:
CITY, STATE, ZIP: ,,
CONTACT:
PHONE #: FAX #:
P.O. #:               
                                                                        Submitters Name

  

NAME:
ADDRESS:
CITY, STATE, ZIP: ,,
CONTACT:
PHONE #: FAX #:
EMAIL ADDRESS:

I hereby authorize HTR to PICKUP the material listed for recycle in accordance with the price QUOTATION and TERMS and CONDITIONS of our contract/agreement.
TYPE UNIT OF
MEASURE		 QUANTITY ORDER TRACKING SYSTEM
1 FOOT FLUORESCENT LAMP/S RECYCLING each (for HTR office use)
2 FOOT FLUORESCENT LAMP/S RECYCLING each ORDER ACKNOWLEDGEMENT
3 FOOT FLUORESCENT LAMP/S RECYCLING each Date: BY:
4 FOOT FLUORESCENT LAMP/S RECYCLING each Via:
5 FOOT FLUORESCENT LAMP/S RECYCLING each BILL OF LADING #
6 FOOT FLUORESCENT LAMP/S RECYCLING each Approximate PICK-UP Date:
7 FOOT FLUORESCENT LAMP/S RECYCLING each PICK-UP Date:
8 FOOT FLUORESCENT LAMP/S RECYCLING each Invoice Date:
UTUBE FLUORESCENT LAMP/S RECYCLING each  
CIRCULAR FLUORESCENT LAMP/S RECYCLING each Approximate pick-up date is subject to change depending on scheduling, load times, weather, mechanical breakdowns, traffic delays, and other conditions beyond HTR control.  HTR dispatcher or driver will confirm pick-up date/time prior to arrival of truck.
COMPACT FLUORESCENT LAMP/S RECYCLING each
HID MERCURY/HALIDE/SODIUM LAMP/S RECYCLING each
SHIELD/COATED/GROOVED LAMP/S RECYCLING each
INCANDESCENT LAMP/S RECYCLING each
UV/ARC/IGNITRON LAMP/S RECYCLING each
BROKEN LAMP/S RECYCLING lbs.
CRUSHED FLUORESCENT LAMP/S RECYCLING lbs. Special Instructions:
PCB BALLAST RECYCLE/INCINERATION lbs.
NON-PCB BALLAST RECYCLE lbs.
ESCRAP RECYCLING lbs.
MERCURY DEVICE RECYCLING lbs.
LEAD ACID BATTERY RECYCLING lbs.
ALKALINE BATTERY RECYCLING lbs.
NICKEL BATTERY RECYCLING lbs.
LITHIUM BATTERY RECYCLING lbs.
MISCELLANEOUS RECYCLING
*Quantities on PICK-UP ORDER subject to actual count by HTR RECEIVING TECHNICIAN  
Site Information: Hours Loading Dock

            Please complete the Order Form and press submit
You may also choose to print, fill-out, and fax this page to submit your order.