Customer Inventory Pickup Request Form

CUSTOMER INVENTORY PICKUP REQUEST

505 North Main Street
North Salt Lake, UT 84054
Phone: 801-299-1900 Ext. 1414
24 Hour: 866-230-8485
Fax: 801-299-1473
EnviroCareUsa.com

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Company Name*

Please type in your Company name

Contact Name*

Please type in your name so we know who to contact regarding this job

E-mail*

Invalid email address.

Phone*

Invalid phone number. Please use only numbers and dashes

Pickup Location or Coordinates*

Please enter the entire address (street address, city, state, zip), location or coordinates where we should pickup your inventory.

Description of Waste

Please describe what you're needing disposal for

Container Type/Size and Quantity

Please enter the Container Type/Size (if known)

Estimated Total Weight

Please enter the estimated total weight

Enviro Care Profile Number (if known)

Please enter the Enviro Care Profile number (if know

Comments or questions

Please enter any additional information you'd like us to know or questions you may have.

Description of Waste

Please describe what you're needing disposal for

Container Type/Size and Quantity

Please enter the Container Type/Size (if known)

Estimated Total Weight

Please enter the estimated total weight

Enviro Care Profile Number (if known)

Please enter the Enviro Care Profile number (if know

Comments or questions

Please enter any additional information you'd like us to know or questions you may have.

Description of Waste

Please describe what you're needing disposal for

Container Type/Size and Quantity

Please enter the Container Type/Size (if known)

Estimated Total Weight

Please enter the estimated total weight

Enviro Care Profile Number (if known)

Please enter the Enviro Care Profile number (if know

Comments or questions

Please enter any additional information you'd like us to know or questions you may have.