Medical Waste Sign Up

135 NW Harold Drive, PO Box 619, Pullman, WA 99163

SERVICE AGREEMENT FOR BIOHAZARDOUS INFECTIOUS WASTE COLLECTION

First Scheduled Pickup Date(Required)

Pickup Location(Required)

Number and Size of BHW Storage Containers(Required)

Client Name(Required)

First Last

Contact

Phone(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Mailing Address (if different)

Street Address Address Line 2 City State ZIP Code

Signature of Authorized Agent, Client(Required)

Date(Required)