CassBioMed On-Demand Medical Waste Removal

Please complete the form to request CheckSammy OnDemand Medical Waste Removal Service
Customer Support Representative Who Is Placing Order*
First Last
Customer Support Rep Email*
Customer Support Phone Number*
Pickup Location Details
Business Name (company)*
Purchase Order # (PO)*
Contact person for Pickup*
First Last
Business Phone (pickup location)*
Business Email (contact person)*
Pickup Location*
Street Address Address Line 2 City State ZIP Code
Service Date & Time
(Same day service available for orders received before 12pm EST)
Requested Pickup Date*
MM slash DD slash YYYY
Requested Pickup Time*

: HH

MM

AM/PM

Arrival will be within 3 hours of time selected
Product Pick-Up Details
Pharma Canisters for Pick-Up
Price: $18.00
RMW Boxes for Pick-Up
Price: $18.00
RCRA Canisters for Pick-Up
Price: $18.00
Replacement Boxes Needed
Price: $0.00
Total Pickup Fees
$0.00
Additional Details
If necessary please provide any addition details about items to be picked-up and any location specifics
Photos of Items for Pick-up
Please provide photos of items to be picked up - the better the visual details of what is to be picked up - the more efficient we can be.
Drop files here or

Accepted file types: jpg, gif, png, pdf, jpeg, Max. file size: 50 MB, Max. files: 15.
Billing Details
This request, once the job is complete, will be invoiced to*
Client Name*
Address*
Street Address Address Line 2 City State ZIP Code
Client Billing Email*
Client Phone*
By clicking submit, I hereby certify that I am an authorized representative for the referenced property for which I am submitting this work order (the “Property”). I have the authority to submit this work order on behalf of the Property, including but not limited to authorization to order the scope of work to be performed under the work order, and (ii) ensure payment for this work. I agree to pay all invoices in full within 30-days.

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Please complete the form to request CheckSammy OnDemand Medical Waste Removal Service.

Please complete the form to request CheckSammy OnDemand Medical Waste Removal Service

Pickup Location Details

Service Date & Time

Product Pick-Up Details

Billing Details

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