Online Pickup Order Form

Pick Up Order Form

(To move between fields, please use the tab key. Hitting the enter key will complete your order)

Person Requesting
Company Name
E-mail Address
Telephone/Nextel Number
Community/Project Site Name
City

Quantity	Product	Pick Up Address	Pick Up Date

In some situations the unit is physically located at a different residential address than the residential address where the unit is being charged to. Please enter the address where the unit is being charged in the above "Pick up Field" and enter the address where the unit is physically located in the "box" below.

PLEASE NOTE: WE ARE LOCATED IN NORTH CAROLINA & SOUTH CAROLINA. OUR MARKET AREA IS IN NORTH CAROLINA AND SOUTH CAROLINA. WE DO NOT PROVIDE PORTABLE TOILETS TO OTHER STATES. WE ALSO DO NOT SALE PORTABLE TOILETS, WE ONLY RENT THEM. IF YOU NEED A PORTABLE TOILET OUTSIDE OF NORTH OR SOUTH CAROLINA, PLEASE CONTACT THE PORTABLE SANITATION ASSOCIATION (WWW.PSAI.ORG) AND THEY CAN GIVE YOU THE NAME OF A COMPANY TO CONTACT IN YOUR AREA.

PORTA-JON

TOLL FREE 1.877.375.8988

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Last modified: October 02, 2007

Created by Pam Russell Copyright © 2000 PORTA-JON. All rights reserved.

Created by Pam Russell
Copyright © 2000 PORTA-JON. All rights reserved.