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

SERVICE AGREEMENT FOR BIOHAZARDOUS INFECTIOUS WASTE COLLECTION

Client Name(Required)

First Last

Email(Required)

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)

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Today's Date

First Scheduled Pickup Date(Required)

Pickup Location(Required)

Number and Size of BHW Storage Containers(Required)

Type of Billing(Required)

Electronic