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You are here >>Dry Waste Pick up request form

Dry Waste Pick up request form

I am a resident of Bangalore, Karnataka.
I would like to donate my household dry waste to Samarthanam Parisara. Please arrange to collect it from our organisation.

Complete Name: *

Address Line 1: *

Address Line 2:

Which part of Bangalore: *

To locate your address, please your provide your area, for example Jayanagar 4th Block

Nearest Landmark: *

Kindly help us locate your easily by sharing the nearest land mark, for example, Near Woody's Restaurant, Next to Bangalore Central

Pincode: *

Mobile: *

Email:

Preferred Pick-up Time: *

Dry Waste:

Please let us know what dry waste you are disposing off. If you want to select multiple items from the list please hold ctrl while selecting the options.

I would like to Donate my waste!: *

Yes

If you 'donate' the dry waste, Samarthanam will get the higher revenue to continue doing its work for the people with disabilities.

Submitted by samarthanam on Thu, 03/25/2010 - 07:19

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