Removal Form
(form 5.6)
Please fill out this form upon removal of any Enviropoles
This form can be used for multiple units in 1 site.
If there are multiple sites, (different physical address) please use a separate form for each.
Ensure you the bar-code of each unit removed.
Date
*
-
Day
-
Month
Year
Date
Service Technician: (please select)
*
Please Select
Cameron Fox
Chris Holwell
Don Mossuto
David Tierney
Oz Bin Cleaning WA
Oz Bin Cleaning NSW
OZ Bin Cleaning QLD
Oz Bin Cleaning SA
Other
Customers name:
*
Customers site name if different:
Site address:
*
Removal Details
Bar-code No. #1
*
Location Details #1
*
Bar-code No #2
Location Details #2
Bar-code No. #3
Location Details #3
Bar-code No. #4
Location Details #4
Bar-code No. #5
Location Details #5
Who is the cleaner: (please select)
*
Please Select
Cameron Fox
Chris Holwell
Don Mossuto
Tony Pernice
Satisfied Cleaning VIC
Satisfied Cleaning WA
Oz Bin Cleaning NSW
Ox Bin Cleaning QLD
Nixon Almeida SA
Other
Has the cleaner been notified
Yes
No
Who instructed the removal
Please Select
Cameron
Shelley
Customer
Other
Additional Comments
Attach images
Select File
Cancel
of
Submit
Should be Empty: