Supply Request Form (OAHU ONLY)
Mahalo nui loa for your participation in the Adopt-A-Highway Program and striving to keep Hawai`i beautiful! Please read the reminders below before you complete your form.

1) Orders must be submitted AT LEAST ONE WEEK before the requested pickup date.
2) Supply pickup appointments can be scheduled TUESDAY to FRIDAY, 7:30 AM - 3:30 PM, with the exception of State holidays.
3) The pickup point is at Kakoi District Office (located in Mapunapuna).
4) After you submit this order request, we will contact you to confirm your appointment and provide directions.
5)  Please do not show up without an appointment confirmation as your supplies will not be available and the office may be closed.

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What is your Adopt-A-Highway Group Number? *
Your Adopt-Highway Group Number is 6 digits (e.g. AAH-001).
What is your Adopt-A-Highway Group Name? *
First Name *
Last Name *
Phone Number *
Please provide 10-digit number with dashes (e.g. 808-123-4567)
E-mail *
Date of Cleanup Event *
Cleanup Events can be conducted on any day of the week. If you are unsure of the date for your next cleanup event, enter a tentative date.
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Requested Pickup Date *
**The supply office is open from TUESDAY - FRIDAY, 8 AM - 3 PM, with the exception of State holidays**
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Time
:
Approximately how many volunteers are you expecting? *
How many safety vests do you need? *
Before ordering vests, please check with the previous volunteer coordinator(s) for you group to make sure that you have received  all leftover supplies from them. If they cannot be found or need to be replaced, please make note.
How many pairs of gloves do you need? *
Before ordering gloves, please check with the previous volunteer coordinator(s) for you group to make sure that you have received all leftover supplies from them. If they cannot be found or need to be replaced, please make note.
How many trash bags do you need? *
Before ordering bags, please check with the previous volunteer coordinator(s) for you group to make sure that you have received all leftover supplies from them. If they cannot be found or need to be replaced, please make note.
Preferred contact method *
Required
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