Drug Disposal Kit Order Form

Disposal Kit Order Form

  • Please enter a number from 1 to 50.
    Case Weight: 26 lbs./Each Case Dimensions: 19.5 x 15.5 x 10
  • MM slash DD slash YYYY
  • If no, a supply truck with a liftgate will be provided.
  • Please also indicate whether there is an elevator or not.

Submit your signed Memorandum of Understanding to info@chpcommunity.org.