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Keep Hopewell Beautiful Supply Request Form

  1. Would you like Keep Hopewell Beautiful to promote this event? (Select Yes or No)*
  2. Equipment (select amount of each that apply)
  4. By signing this disclaimer, you agree with and will adhere to the following:

    "I have signed out the items checked below from the Hopewell Department of Development (Clean City Commission) located at 300 North Main Street, Room 321, Hopewell, Virginia 23860 to clean/beautify the assigned area on the assigned date.

    I understand that I am responsible for returning the items checked below to the Department of Development within four days of the date they were checked out. Should I be unable to return the items within 4 days or if the items will be returned by someone other than myself I will contact the Department of Development at (804) 541-2220 and notify them when the items will be returned and who will return them. Failure to return the items after seven (7) days of checkout will result in the suspension of the organization from the Adopt a Street/Spot Program and will require the organization to pay replacement cost of the unreturned items."

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  6. This field is not part of the form submission.