Application for Service Initiating service is easy; click here to download a PDF version of this application or fill out the form below. Fill in your information below. Click ‘submit’. Confirmation call will follow within one business day. Questions? Call us toll-free at 888-317-5860. Application Information Fields marked with an * are required.Facility Name*Contact*Address*Street AddressAddress Line 2CityState / Province / RegionZIP / Postal CodePhone*(xxx)xxx-xxxxFaxEmail*RMW Generator ID# (NJ accounts only)How did you find us?*Your Hours of OperationOpenMondayN/A8:00 AM8:15 AM8:30 AM8:45 AM9:00 AM9:15 AM9:45 AM10:00 AM10:15 AM10:30 AM10:45 AM11:00 AM11:15 AM11:30 AM11:45 AM12:00 PM12:15 PM12:30 PM12:45 PM1:00 PM1:15 PM1:30 PM1:45 PM2:00 PM2:15 PM2:30 PM2:45 PM3:00 PM3:15 PM3:30 PM3:45 PM4:00 PM4:15 PM4:30 PM4:45 PM5:00 PM5:15 PM5:30 PM5:45 PM6:00 PMTuesdayN/A8:00 AM8:15 AM8:30 AM8:45 AM9:00 AM9:15 AM9:45 AM10:00 AM10:15 AM10:30 AM10:45 AM11:00 AM11:15 AM11:30 AM11:45 AM12:00 PM12:15 PM12:30 PM12:45 PM1:00 PM1:15 PM1:30 PM1:45 PM2:00 PM2:15 PM2:30 PM2:45 PM3:00 PM3:15 PM3:30 PM3:45 PM4:00 PM4:15 PM4:30 PM4:45 PM5:00 PM5:15 PM5:30 PM5:45 PM6:00 PMWednesdayN/A8:00 AM8:15 AM8:30 AM8:45 AM9:00 AM9:15 AM9:45 AM10:00 AM10:15 AM10:30 AM10:45 AM11:00 AM11:15 AM11:30 AM11:45 AM12:00 PM12:15 PM12:30 PM12:45 PM1:00 PM1:15 PM1:30 PM1:45 PM2:00 PM2:15 PM2:30 PM2:45 PM3:00 PM3:15 PM3:30 PM3:45 PM4:00 PM4:15 PM4:30 PM4:45 PM5:00 PM5:15 PM5:30 PM5:45 PM6:00 PMThursdayN/A8:00 AM8:15 AM8:30 AM8:45 AM9:00 AM9:15 AM9:45 AM10:00 AM10:15 AM10:30 AM10:45 AM11:00 AM11:15 AM11:30 AM11:45 AM12:00 PM12:15 PM12:30 PM12:45 PM1:00 PM1:15 PM1:30 PM1:45 PM2:00 PM2:15 PM2:30 PM2:45 PM3:00 PM3:15 PM3:30 PM3:45 PM4:00 PM4:15 PM4:30 PM4:45 PM5:00 PM5:15 PM5:30 PM5:45 PM6:00 PMFridayN/A8:00 AM8:15 AM8:30 AM8:45 AM9:00 AM9:15 AM9:45 AM10:00 AM10:15 AM10:30 AM10:45 AM11:00 AM11:15 AM11:30 AM11:45 AM12:00 PM12:15 PM12:30 PM12:45 PM1:00 PM1:15 PM1:30 PM1:45 PM2:00 PM2:15 PM2:30 PM2:45 PM3:00 PM3:15 PM3:30 PM3:45 PM4:00 PM4:15 PM4:30 PM4:45 PM5:00 PM5:15 PM5:30 PM5:45 PM6:00 PMCloseMondayN/A8:00 AM8:15 AM8:30 AM8:45 AM9:00 AM9:15 AM9:45 AM10:00 AM10:15 AM10:30 AM10:45 AM11:00 AM11:15 AM11:30 AM11:45 AM12:00 PM12:15 PM12:30 PM12:45 PM1:00 PM1:15 PM1:30 PM1:45 PM2:00 PM2:15 PM2:30 PM2:45 PM3:00 PM3:15 PM3:30 PM3:45 PM4:00 PM4:15 PM4:30 PM4:45 PM5:00 PM5:15 PM5:30 PM5:45 PM6:00 PMTuesdayN/A8:00 AM8:15 AM8:30 AM8:45 AM9:00 AM9:15 AM9:45 AM10:00 AM10:15 AM10:30 AM10:45 AM11:00 AM11:15 AM11:30 AM11:45 AM12:00 PM12:15 PM12:30 PM12:45 PM1:00 PM1:15 PM1:30 PM1:45 PM2:00 PM2:15 PM2:30 PM2:45 PM3:00 PM3:15 PM3:30 PM3:45 PM4:00 PM4:15 PM4:30 PM4:45 PM5:00 PM5:15 PM5:30 PM5:45 PM6:00 PMWednesdayN/A8:00 AM8:15 AM8:30 AM8:45 AM9:00 AM9:15 AM9:45 AM10:00 AM10:15 AM10:30 AM10:45 AM11:00 AM11:15 AM11:30 AM11:45 AM12:00 PM12:15 PM12:30 PM12:45 PM1:00 PM1:15 PM1:30 PM1:45 PM2:00 PM2:15 PM2:30 PM2:45 PM3:00 PM3:15 PM3:30 PM3:45 PM4:00 PM4:15 PM4:30 PM4:45 PM5:00 PM5:15 PM5:30 PM5:45 PM6:00 PMThursdayN/A8:00 AM8:15 AM8:30 AM8:45 AM9:00 AM9:15 AM9:45 AM10:00 AM10:15 AM10:30 AM10:45 AM11:00 AM11:15 AM11:30 AM11:45 AM12:00 PM12:15 PM12:30 PM12:45 PM1:00 PM1:15 PM1:30 PM1:45 PM2:00 PM2:15 PM2:30 PM2:45 PM3:00 PM3:15 PM3:30 PM3:45 PM4:00 PM4:15 PM4:30 PM4:45 PM5:00 PM5:15 PM5:30 PM5:45 PM6:00 PMFridayN/A8:00 AM8:15 AM8:30 AM8:45 AM9:00 AM9:15 AM9:45 AM10:00 AM10:15 AM10:30 AM10:45 AM11:00 AM11:15 AM11:30 AM11:45 AM12:00 PM12:15 PM12:30 PM12:45 PM1:00 PM1:15 PM1:30 PM1:45 PM2:00 PM2:15 PM2:30 PM2:45 PM3:00 PM3:15 PM3:30 PM3:45 PM4:00 PM4:15 PM4:30 PM4:45 PM5:00 PM5:15 PM5:30 PM5:45 PM6:00 PMInitial Container Delivery Container charges are billed at the time of delivery and at the time of removal. Invoices are mailed monthly, and can be paid via check or credit card.First 17-Gallon ContainerPrice: $60.00 Quantity: First 31-Gallon ContainerPrice: $96.00 Quantity: First 43-Gallon ContainerPrice: $108.00 Quantity: Each Additional 17-Gallon ContainersPrice: $60.00 Quantity: Each Additional 31-Gallon ContainersPrice: $48.00 Quantity: Each Additional 43-Gallon ContainersPrice: $54.00 Quantity: 2-Gallon Disposable Sharps CollectorPrice: $9.60 Quantity: 5.4 Quart Sharps Collector Wall BracketPrice: $30.60 Quantity: (Does not include 5.4 Quart Sharps Collector)5.4 Quart Sharps CollectorPrice: $10.20 Quantity: Total$0.00Additional InstructionsPlease state any special instructions related to servicing your facility:This application will serve as a non-time-binding agreement between Orchard Hill Medical Waste Disposal, hereinafter referred to as the “transporter” and the applicant, hereinafter referred to as the “generator”. The Transporter: The transporter will provide specifically-designed containers to meet or exceed all local, state and federal guidelines for the containment and transportation of regulated or over-classified medical wastes. Containers may be filled with all types of over-classified and regulated medical waste, excluding improperly packaged bulk liquids and waste classified as ‘hazardous’. Only 17 Gal containers may contain loose sharps. 31 and 43 Gal containers require the use of disposable collectors. The transporter will provide an applicable state environmental tracking form for use in all waste removals. Proof of disposal certifications will be returned to the generator by the incineration facility within 14 days of processing. The transporter will provide the generator with an itemized invoice for each service call, monthly statements and back-up copies of disposal certificates. The transporter will respond to all requested service calls within five working days and only during the generator’s specified hours of operation (as defined on the Service Application). Hours of operation will be calculated according to the generator’s schedule (excluding weekends and holidays). The Generator: The generator will provide the transporter with a valid state RMW generator registration number (if required by state regulation). Requests for service will be made by telephone to 888-317-5860. The generator will also ensure that a properly-completed tracking form accompanies each waste consignment intended for removal (forms to be supplied by transporter). The generator agrees to rent re-usable containers according to current pricing at the time of requests for service (prices may change based on prevailing market disposal rates). The generator will ensure that all waste containers are sealed prior to removal. The Generator assumes responsibility for re-usable containers while on-site at Generator’s location, including the replacement cost of any rented containers that are unrecoverable due to loss or damage. Re-usable containers may remain on-site for a maximum of 12 months. The generator agrees to pay all charges to the transporter within 30 days. Delinquent accounts will be charged 1.5% per month. The generator agrees to pay a $50 incomplete service charge to the transporter for requested service calls that do not meet the requirement of simultaneous container removal and delivery, and for attempted service calls that are incomplete due to the generator’s facility being closed during specified hours of operation. The generator may submit written cancellation of this agreement at any time.
