Rx Destroyer TM Pharmaceutical Disposal701 Blackhawk Dr, Suite FBurlington, Wisconsin 53105 Toll free: (888) 608-5160Fax: 262-457-4977 Your Name (required) Company Name (required) Your Email (required) Your Phone (required) What Type of Products Are you Interested in? ---Rx Destroyer™ All PurposeRx Destroyer™ for LiquidsAccessoriesI'm Not SureHold down the CTRL key to select multiple items What size are you most interested in (if applicable) ---16oz.32oz.64oz.1 Gallon2.5 Gallon5 Gallon30 GallonHold down the CTRL key to select multiple items How did you hear about Rx Destroyer™? (please select 1) ---Trade ShowEmailInternet SearchCatalogColleagueOther How can we be of assistance? This form collects your name, email, phone number and other information to help us serve you. This information may be stored for later use by Rx Destroyer. Please check this box to confirm that you understand this.