Client Registration & Setup

Name*

First NameLast Name

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Business Name*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Pickup Frequency

Container Sizes

Quantity of Containers

	Quantity
1 Quart
2 Quart
5 Quart
1 Gallon
2 Gallon
5 Gallon

Date*

Date

Proof Of Business Insurance*

Bloodborne Pathogen Certificate*

BIOSECURE TRANSPORT SERVICE AGREEMENT
This Service Agreement (Agreement) is entered into by and between BioSecure Transport (Service Provider) and the client identified in the Client Registration & Setup Form (Client).

1. SERVICES
BioSecure Transport agrees to provide medical sharps waste pickup, transportation, and disposal services as selected by the Client.

2. SCHEDULING & CONTAINER USE
The Client shall select the container type(s) and pickup frequency. Containers must be properly sealed and stored in a safe, accessible location. Improperly packaged or unsecured waste may result in refusal of service.

3. COMPLIANCE
Client certifies they are a generator of medical waste and agrees to maintain compliance with all local, state, and federal regulations related to the handling, storage, and generation of sharps waste. Client is responsible for ensuring their staff are trained in proper sharps container usage and packaging.

4. DOCUMENTATION
Client agrees to submit proof of general liability insurance and valid bloodborne pathogen training certification. Updated documentation must be provided annually or upon request.

5. PAYMENT TERMS
Invoices are due upon receipt unless otherwise specified. Missed pickups due to inaccessible containers or client unavailability may result in a full-service charge.

6. CANCELLATION POLICY
Clients who cancel scheduled service with less than 24 hours notice may be billed the full pickup fee. Emergencies may be considered on a case-by-case basis.

7. TERMINATION
This Agreement may be terminated by either party with written notice. BioSecure Transport reserves the right to terminate service for non-compliance, unpaid invoices, or unsafe collection conditions. Upon termination, Client remains responsible for any outstanding balances.

8. LIABILITY
BioSecure Transport assumes no liability for waste that is not packaged according to regulation or that is mishandled prior to pickup. Client holds BioSecure Transport harmless for damages or losses resulting from non-compliant waste or improperly stored containers.
IN WITNESS WHEREOF, the Client agrees to the terms above and acknowledges that this Agreement shall govern their relationship with BioSecure Transport.

I have read and agree to the terms outlined in the Service Agreement*

I agree

Generator Certification: I certify that I am the generator of the medical waste being submitted for pickup and disposal.

I agree

I hereby consent to have BioSecure Transport to pick up my biohazard waste and send off for treatment and destruction.*

I agree

I acknowledge payment is due at pick up and there are no refunds.*

I agree

Client Signature*

Once you click submit, our team will review your registration form and follow up within 1 -2 business days. You'll receive a confirmation of your service setup or a request for any additional information if needed.

If you have any questions or need an immediate pickup, feel free to email us.

Thank you for your business!

BioSecure Transport

BioSecure Transport - Client Registration & Setup