Fillable Appliance-pickup-request - Appliance Request

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Appliance-pickup-request - Appliance Request

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Town Of Cheverly
6401 Forest Road
Cheverly, Md. 20785
301-773-2666
APPLICANCE PICKUP REQUEST
NOTE:
The Town must receive payment before a Pick-up Date will be scheduled. Appliances may only
be placed at the curb the night before the scheduled pickup date.
ADDRESS: _____________________________________
NAME: ________________________________________
Daytime Phone Number ___________________________
List Appliance(s) to be picked up _______________________________________________
_______________________________________________
_______________________________________________
PICK-UP CHARGE $20.00
*If you have more than one appliance to be picked up add $10 for each additional appliance.
FOR OFFICE USE ONLY
AMT. PAID: ____________
Date Paid: ____________
Rec. by: ____________
Date of Picku
p
Examples of Appliances:
Stove, Refrigerator, Freezer, Dishwasher, Washer, Dryer, Air Conditioner, Microwave,
Oven, Water heater, etc.
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Completed 11 July 2020

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