Facilities Management
Bottled Gas Request Form

For questions call:

Warehouse at 835-5844

 Back to Facilities Management
1 - Choose the building from the list below:
Building: Room Number: Specialty gas orders must be placed by 2pm Wednesday for delivery on Friday afternoon. For regular gas orders, you will be contacted for delivery as soon as your request is received. IT IS REQUIRED that you be available to sign for delivery. PLEASE NOTE that you will be charged EXTRA for each attempted delivery.

PLEASE NOTE: All orders placed on Friday will be delivered the following Monday. 
Other Building:  
 


2 - Choose the Department and Enter the Account Number you wish to use:
Department:


Other Department:

     Banner FOAP account numbers are required for all Bottled Gas Requests to be processed. The ACCT value is assumed to be 710001 for Bottled Gas orders.

Know your old account number?
Look-up the new numbers here
Enter your complete FOAP number
FUND
 		ORGN
 		ACCT
 		PROG


3 - Enter your contact information:
Your Name: Your E-Mail Address: (required) Your Telephone Number:

What type and quantity of gas do you require?

 Enter a quantity for each type of gas you require

Will you pickup these new tanks or would you like them delivered?

*Orders placed on Friday will be delivered the following Monday. Delivery charge is $7.50 per tank ordered - We will call you to schedule time of delivery 

Do you require old tanks to be picked up?

If you require tanks be picked up, please indicate the type and quantities below:
(one type per line please)

*If you chose Other Gas, please enter the name of the gas you require:
250 Characters Max.

Type QTY Type QTY
Acetylene Helium
Acetylene "B"
(Small Tank)		 Helium, UHP
0.1 Air
(Zero Air)		 Hydrogen
Air Breathing Hydrogen, UHP
Air Compressed MAPP Gas
Air Dry Nitrogen
Argon Nitrogen, Liquid
Argon Liquid Nitrogen, UHP
Argon, UHP Nitrous Oxide
CO2 Oxygen
CO2 w/Siphon Other Gas*

Would you like to be called about this Gas order?
 No Yes