Empty Cylinder Return Request

Please fill out and submit this form to request an empty cylinder return. If you have questions, please call 303-492-6369

Contact Name (First and Last) *

Contact Phone # *

E-mail *

Department *

Building *

Room Number *

Cylinder Vendor

Airgas

Other

Speedtype for shipping (we only need a speedtype if you are returning a non-Airgas cylinder) *

Cylinder Type

	Air, compressed	Argon, compressed	Carbon dioxide	Helium, compressed	Nitrogen, compressed	Oxygen, compressed	Hydrogen, compressed	Gas, compressed NOS	Other (please specify below)
Cylinder 1	Cylinder 1 - Air, compressed	Cylinder 1 - Argon, compressed	Cylinder 1 - Carbon dioxide	Cylinder 1 - Helium, compressed	Cylinder 1 - Nitrogen, compressed	Cylinder 1 - Oxygen, compressed	Cylinder 1 - Hydrogen, compressed	Cylinder 1 - Gas, compressed NOS	Cylinder 1 - Other (please specify below)
Cylinder 2	Cylinder 2 - Air, compressed	Cylinder 2 - Argon, compressed	Cylinder 2 - Carbon dioxide	Cylinder 2 - Helium, compressed	Cylinder 2 - Nitrogen, compressed	Cylinder 2 - Oxygen, compressed	Cylinder 2 - Hydrogen, compressed	Cylinder 2 - Gas, compressed NOS	Cylinder 2 - Other (please specify below)
Cylinder 3	Cylinder 3 - Air, compressed	Cylinder 3 - Argon, compressed	Cylinder 3 - Carbon dioxide	Cylinder 3 - Helium, compressed	Cylinder 3 - Nitrogen, compressed	Cylinder 3 - Oxygen, compressed	Cylinder 3 - Hydrogen, compressed	Cylinder 3 - Gas, compressed NOS	Cylinder 3 - Other (please specify below)
Cylinder 4	Cylinder 4 - Air, compressed	Cylinder 4 - Argon, compressed	Cylinder 4 - Carbon dioxide	Cylinder 4 - Helium, compressed	Cylinder 4 - Nitrogen, compressed	Cylinder 4 - Oxygen, compressed	Cylinder 4 - Hydrogen, compressed	Cylinder 4 - Gas, compressed NOS	Cylinder 4 - Other (please specify below)
Cylinder 5	Cylinder 5 - Air, compressed	Cylinder 5 - Argon, compressed	Cylinder 5 - Carbon dioxide	Cylinder 5 - Helium, compressed	Cylinder 5 - Nitrogen, compressed	Cylinder 5 - Oxygen, compressed	Cylinder 5 - Hydrogen, compressed	Cylinder 5 - Gas, compressed NOS	Cylinder 5 - Other (please specify below)
Cylinder 6	Cylinder 6 - Air, compressed	Cylinder 6 - Argon, compressed	Cylinder 6 - Carbon dioxide	Cylinder 6 - Helium, compressed	Cylinder 6 - Nitrogen, compressed	Cylinder 6 - Oxygen, compressed	Cylinder 6 - Hydrogen, compressed	Cylinder 6 - Gas, compressed NOS	Cylinder 6 - Other (please specify below)
Cylinder 7	Cylinder 7 - Air, compressed	Cylinder 7 - Argon, compressed	Cylinder 7 - Carbon dioxide	Cylinder 7 - Helium, compressed	Cylinder 7 - Nitrogen, compressed	Cylinder 7 - Oxygen, compressed	Cylinder 7 - Hydrogen, compressed	Cylinder 7 - Gas, compressed NOS	Cylinder 7 - Other (please specify below)
Cylinder 8	Cylinder 8 - Air, compressed	Cylinder 8 - Argon, compressed	Cylinder 8 - Carbon dioxide	Cylinder 8 - Helium, compressed	Cylinder 8 - Nitrogen, compressed	Cylinder 8 - Oxygen, compressed	Cylinder 8 - Hydrogen, compressed	Cylinder 8 - Gas, compressed NOS	Cylinder 8 - Other (please specify below)
Cylinder 9	Cylinder 9 - Air, compressed	Cylinder 9 - Argon, compressed	Cylinder 9 - Carbon dioxide	Cylinder 9 - Helium, compressed	Cylinder 9 - Nitrogen, compressed	Cylinder 9 - Oxygen, compressed	Cylinder 9 - Hydrogen, compressed	Cylinder 9 - Gas, compressed NOS	Cylinder 9 - Other (please specify below)
Cylinder 10	Cylinder 10 - Air, compressed	Cylinder 10 - Argon, compressed	Cylinder 10 - Carbon dioxide	Cylinder 10 - Helium, compressed	Cylinder 10 - Nitrogen, compressed	Cylinder 10 - Oxygen, compressed	Cylinder 10 - Hydrogen, compressed	Cylinder 10 - Gas, compressed NOS	Cylinder 10 - Other (please specify below)
Cylinder 11	Cylinder 11 - Air, compressed	Cylinder 11 - Argon, compressed	Cylinder 11 - Carbon dioxide	Cylinder 11 - Helium, compressed	Cylinder 11 - Nitrogen, compressed	Cylinder 11 - Oxygen, compressed	Cylinder 11 - Hydrogen, compressed	Cylinder 11 - Gas, compressed NOS	Cylinder 11 - Other (please specify below)
Cylinder 12	Cylinder 12 - Air, compressed	Cylinder 12 - Argon, compressed	Cylinder 12 - Carbon dioxide	Cylinder 12 - Helium, compressed	Cylinder 12 - Nitrogen, compressed	Cylinder 12 - Oxygen, compressed	Cylinder 12 - Hydrogen, compressed	Cylinder 12 - Gas, compressed NOS	Cylinder 12 - Other (please specify below)
Cylinder 13	Cylinder 13 - Air, compressed	Cylinder 13 - Argon, compressed	Cylinder 13 - Carbon dioxide	Cylinder 13 - Helium, compressed	Cylinder 13 - Nitrogen, compressed	Cylinder 13 - Oxygen, compressed	Cylinder 13 - Hydrogen, compressed	Cylinder 13 - Gas, compressed NOS	Cylinder 13 - Other (please specify below)
Cylinder 14	Cylinder 14 - Air, compressed	Cylinder 14 - Argon, compressed	Cylinder 14 - Carbon dioxide	Cylinder 14 - Helium, compressed	Cylinder 14 - Nitrogen, compressed	Cylinder 14 - Oxygen, compressed	Cylinder 14 - Hydrogen, compressed	Cylinder 14 - Gas, compressed NOS	Cylinder 14 - Other (please specify below)
Cylinder 15	Cylinder 15 - Air, compressed	Cylinder 15 - Argon, compressed	Cylinder 15 - Carbon dioxide	Cylinder 15 - Helium, compressed	Cylinder 15 - Nitrogen, compressed	Cylinder 15 - Oxygen, compressed	Cylinder 15 - Hydrogen, compressed	Cylinder 15 - Gas, compressed NOS	Cylinder 15 - Other (please specify below)
Cylinder 16	Cylinder 16 - Air, compressed	Cylinder 16 - Argon, compressed	Cylinder 16 - Carbon dioxide	Cylinder 16 - Helium, compressed	Cylinder 16 - Nitrogen, compressed	Cylinder 16 - Oxygen, compressed	Cylinder 16 - Hydrogen, compressed	Cylinder 16 - Gas, compressed NOS	Cylinder 16 - Other (please specify below)

If other cylinder type, describe

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Empty Cylinder Return Request