Contact information |
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| Organization Name: | |
| Contact name*: | |
| Contact phone*: | |
| Contact Email: | |
Pick-up information |
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| Pick-up street address: | |
| Zip code*: | |
X-rays lot information (optional) |
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| Total number of boxes ready: (if in boxes) | |
| Type of film: | |
Preferred pick-up date and time.We pickup any business day with 1 day notice, we need a 3 hours window for the pick-up. |
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| Please mention your preferred pick-up date and time. Feel free to add any comments about the pick-up. |
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