Solid Waste Authority of Palm Beach County
Customer Information Services Community Services
Residential Recycled Paint Donation Application
*Select ONLY- (2) colors – 1- Base & 1- Trim*
Mark an (X) by your color selection
Please note that paint is for EXTERIOR use only and all buildings must be pressure cleaned
prior to receiving a recycled paint donation. Paint is NOT suitable for use in sprayers.
(Single Family Homes ONLY - Total square Footage cannot exceed 3000 sq. ft.)
For Non-Profit organizations, a copy of Recipient’s IRS 501c3 or other tax-exempt documentation must be provided at time of application.
Recipient agrees to protect, defend, indemnify, and hold harmless the SWA, its employees and representatives, from any and all claims
and liabilities including all attorney’s fees and court costs, including appeals, for which the SWA, its employees and representatives, can
or may be held liable as a result of injury (including death) to persons or damage to property occurring by reason of any wrongful acts or
omissions of the Recipient, its employees or agents, in the performance of Services under this Agreement, of rising out of use of SWA
Donated Recycled Paint.
Signature: Date:
Upon review and approval of application, you will be notified when to pick up the requested paint order.
Muni. Code ____Square Footage: ____ SWA Note #: _
Pressure Cleaned:
Qualifying Notes:
Approved by: Date:
Attempts to Contact
1. ________________________________
2. ________________________________
3. ________________________________
Pick up Date: Time: Vehicle Color/Type:
Paint Received By: Date:
(Rev: 8/31/11) Hold for Pick Up _____________ Hold for Delivery ________________
(Subject to availability)
(Office
Off White
(OFFICE USE ONLY)
Please complete and return or fax to:
Solid Waste Authority
Customer Information Services
7501 North Jog Road
West Palm Beach, FL 33412
Phone - (561) 697-2700 ext 4701 or 4717
Toll Free - 1-866-SWA-INFO (792-4636)
Fax - (561) 640-3400
Name: ___________________________________________________________
Address: __________________________________________________
City, State, Zip: _____________________________________________
Phone Number: ( ) _____________________________________
Fax Number: ( ) _______________________________________
E-mail address: ____________________________________________