Stella-Jones Corporation Pole Pickup Form

Pole Pickup Form

This form is for pole pickup only!
REQUIRED FIELDS marked with * (For multiple choice options one choice must be marked or filled in. Form cannot be submitted unless all required fields are completed)

Date * (mm/dd/yyyy)	Requestor's name*
Phone* (555-555-5555)	Email*
Region

Notify me that Pole Pickup is complete by: (please mark only if you require notification) Phone Email
Is this an External Customer Complaint? * Yes No Note: If this is an External Customer Complaint, a phone call MUST be made to 866-955-6751 to expedite the pickup.

Pole Information:
Original MR#*	Original WO#*
Pole Size*	Number of Pieces* (12 ft min per piece)
Pole Type* New Old

Pole Pickup Location:
Address*	Cross Street (nearest)*
City*	County*
Map and/or Quad*	GPS Coordinate (if available)
Additional Information

Pole Pickup Form

Pole Information:

Pole Pickup Location: