Mercury Disposal Systems Inc. 

   Fast -Trac pick-up request          

 Please fill out the requested information below and our Representative will contact you shortly to arrange a  day and time to schedule your pick-up.

 If you will be needing replacement containers or boxes, please let us know what size and they will be delivered  at time of pick-up. 

           Thank You                                                                                                                                               

* Required fields

Name *

E-mail Address *

Company name *

Address *

City *

Zip *

Contact Phone number *

Need pick-up for * lamps Batteries Both Other

Items are boxed and ready now *

How many containers do you have for pick-up * 1-5 5-10 over 10

Do you need replacement containers Yes No

I have read and agree to the Privacy Policy *

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