Request Empty Cylinder Pick-Up

# of Cylinders(Required)

Refrigerant Previously Found in Cylinder(Required)

Cylinder Size(Required)

Your Purchase Order #(Required)

Note: If return consists of multiple PO or Invoice #s, please list above and separate by comma

USA Refrigerants Invoice #(Required)

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# of Cylinders(Required)

Refrigerant Previously Found in Cylinder(Required)

Cylinder Size(Required)

Your Purchase Order #(Required)

Note: If return consists of multiple PO or Invoice #s, please list above and separate by comma

USA Refrigerants Invoice #(Required)

Check Here to Add More

# of Cylinders(Required)

Refrigerant Previously Found in Cylinder(Required)

Cylinder Size(Required)

Your Purchase Order #(Required)

Note: If return consists of multiple PO or Invoice #s, please list above and separate by comma

USA Refrigerants Invoice #(Required)

Total Number of Pallets(Required)

Company Name(Required)

Name(Required)

First Name (Required) Last Name (Required)

Title(Required)

Email(Required)

Phone Number(Required)

Pickup Address(Required)

Street Address (Required) Address Line 2 City (Required) State / Province / Region (Required) ZIP / Postal Code (Required) Country