Schedule My Dental Scrap Pick-Up
Simply Answer questions  below and CLICK the SUBMIT button just below # 7

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1. Who Do You Want Us To Pay - ? *
MANDATORY: Please Provide The Name Of The Party We Will Be Paying For The Dental Scrap
1a. First Name *
1b. Last Name
2a. Street Address
OPTIONAL: Where Do You Want Your Payment Sent? (Leave this blank if you want us to call you for these details)
2b. City
OPTIONAL: Where Do You Want Your Payment Sent? (Leave this blank if you want us to call you for these details)
2c. State/Province
OPTIONAL: Where Do You Want Your Payment Sent? (Leave this blank if you want us to call you for these details)
2d. Zip Code
OPTIONAL: Where Do You Want Your Payment Sent? (Leave this blank if you want us to call you for these details)
3. Where Should We Email Your Prepaid Label?
OPTIONAL: Include your Email address where we can send your prepaid label
4. What Phone Number Can We Text Your Tracking Number? *
MANDATORY: We need a phone number in order to confirm the pick-up details
5. What Day & Time Do You Want The Pick-Up Scheduled?
OPTIONAL: (Leave this blank if you want us to call you for these details) MM/DD/YYYY - HH:MM -  AM/PM
6. How Would You Prefer To Be Paid?
OPTIONAL: (Leave this blank if you want us to call you for these details)
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7. Do You Have Questions Or Comments?
OPTIONAL: Please provide any special instructions you need us to follow
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