Request litter picking equipment

Please read the guidance notes before completing this form.
Fields marked with * are required
Equipment details
1. What equipment do you require?*
  
  Bags
  
  Litter pickers (15 per bag)
  
  Both
2. Where would you like to collect your litter picking equipment?
  
  Dereham - Breckland Council Offices
  
  Swaffham - Iceni Partnership
  
  Watton - Wayland Hall
  
  Thetford - Thetford Town Council
  
  Attleborough - Attleborough Town Council
3. How many bags of litter pickers required? (maximum of 2 for Dereham )
4. What date do you wish to collect equipment? (DD/MM/YYYY)
  Please provide at least 10 working days notice
  
  Day
  
  Month
  
  Year
Bags Only
1. Please note we will arrange for the equipment to be delivered to your address (address details to be supplied at end of form)
Are collecting this litter as a group or an individual?*
1. Group
2. Individual
Group Details
1. Name of group

Session timeout