Your Information:
Business Name
Contact Name
Address
City
State
CT
MA
NY
RI
Zip Code
E-mail
Phone
Fax
Who is Your Current Transporter?
When does your current contract expire?:
Comments
and/or Questions:
Service Requirement:
Number of service locations of company:
Medical Waste Pickup Frequency
Daily
Weekly
2 Weeks
4 Weeks
6 Weeks
12 Weeks
2 Times/Year
Medical Waste Current Box Size
2.2 CF (14x14x18")
4.6 CF(18x18x22")
Medical Waste # of Boxes Each Pickup each location
X-Ray Waste Service Needed
Yes
No
X-Ray Waste Size of Container
5 Gallon
10 Gallon
50 Gallon
X-Ray Waste # of Containers Each Pickup
© 2009 All rights reserved. BIO Methods LLC.
CT Website Design By: CT Web Factory, LLC.
