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Anti-Graffiti Paint & Supply Voucher Application


Instructions: Fill out all of the information on the application completely and correctly.  Be sure to include addresses of all properties that will be cleaned of graffiti.  Write the number of gallons of each color requested as well as the number of supplies if needed.  After verification is made, the turn around time to receive your voucher is approximately one week.  If you have any questions, please call (215) 686-2112.

(If graffiti is on brick or stone surface (non-painted), you may request powerwashing service by going to our online Graffiti Removal Form at www.phila.gov/antigraffiti/) 

* Denotes a required field

 

A PDF version of this form is available here

311 Tracking #
(for staff use only)

Organization Name
 *Contact Person
*Mailing Address
 *Zip Code
*Date
 *Phone #
Work #
 Fax #
Date of Cleanup
 Council District
Police District
  
Gallons of Paint Requested (Quantity)
Black
Supplies Requested (Quantity)

Roller Handles 

Extension Poles  
Properties to be cleaned (Please write exact addresses for verification purposes.)
At Least One Address Required (*please include zip code)

 Address

Paint Color

Release form (check if appropriate)