MED-FLEX

*Company:

*Contact Person:

*Address:

*City:

*Zip:

*Phone:

Fax:

*Email:

What type of facility are you?

Are you currently having your medical waste picked up by someone? Yes No

How often do you need to be picked up?*

What type of medical waste does your facility/office generate? (check all that apply)

How much medical waste does your facility generate per pickup?

Do you have additional sites that you would like us to quote for? Yes No

Additional Comments:

*Validation:


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