WMPharma On-Demand Medical Waste Removal

Waste Management Medical Waste Removal Request
Please complete the form to request CheckSammy OnDemand Medical Waste Removal Service
Waste Management Contact Placing Order*
First Last
Email*
Phone*
Pickup Location Details
Location ID*
Billing Reference*
Business Name*
Contact Person for Pickup
First Last
Business Email (for pickup reminder)*
Business Phone (pickup location)*
Pickup Address*
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*
Arrival will be within 2 hours of time selected
Product Pick-Up Details
Pharma Canisters for Pick-Up Quantity
Price:$18.00
RMW Boxes for Pick-Up Quantity
Price:$18.00
RCRA Canisters for Pick-Up Quantity
Price:$18.00
Replacement Boxes Needed Quantity
Price:$0.00
Total Pickup Fee
$0.00
Additional Details
If necessary please provide any addition details about items to be picked-up and any location specifics
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.
Name
This field is for validation purposes and should be left unchanged.

Waste Management Medical Waste Removal Request