Pick Up Request - Westox Labs

Pick Up

If you are human, leave this field blank.

Email Address *

Account Manager Name *

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 *

Pick Up Window (Monday through Friday only. Order must be placed by 3PM PST to be picked up the same 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)