Schedule/Request for a UPS Pickup

Fill out the below form and click Submit to request UPS pickup to ship your package to Derby Dental Laboratory.

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* Required Field
Pickup From Address
 
Contact Name *
Company *
Address *
City *
State *
Postal Code *
Phone Number *
 
Pickup Date/Time
Ready Time * hh:ii A
Pickup Date* mm/dd/YYYY
Closing Time * hh:ii A
 
Special Instructions
Special Instructions
 
Security Code
Security Code*
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