Submit a request – Waste Commission of Scott County

Please tell us about your inquiry.

Your email address

Subject

Name

Full name

Phone Number

Use dashes: xxx-xxx-xxxx

Organization

Name of group or organization

Date of Cleanup

Event Location

Line 1: Street Address; Line 2: City, State, Zip *Must be in Scott or Rock Island County

Number of volunteers

Anticipated number of volunteers

What supplies do you need?

Check all that apply. Supply quantities will be based on number of volunteers.

Supply Pickup Date

Between 8:30am–4:00pm weekdays.

Extra Supply Return Date

Between 8:30am–4:00pm weekdays

Description

Please enter more details of your request. If none, enter "N/A". A member of our staff will respond as soon as possible.

I have read and understand the guidelines for use and return of supplies.

Attachments(optional)

Add file or drop files here