Pick Up Request - Westox Labs

Email Address *

Westox Account Manager *

Facility Name *

Pick Up Attention To *

Facility Phone Number (No Dashes or Parentheses) *

Facility Address (Street Address, Apt/Suite #, City, State, Zip Code) *

Pickup Date (Monday through Friday only. *Order must be placed by 3PM PST to be picked up the same day.* Any requests made outside of business hours will be handled on the next business day.) *

Pick Up Window (*Order must be placed by 3PM PST to be picked up the same day.* Any requests made outside of business hours will be handled on the next business day.) *

List Other Pick Up Window (3 hours required)

Ready Now? *

Yes, ASAP

No, Please pick up per delivery window.

Frequency of Pick Up

One time (on-call pick up)

Set up as scheduled pick up.*

*Please detail the new pick up schedule if chosen above. (Example: MTWTF, 12PM-4PM)