Facilities Management Bottle Gas Request

For Delivery Questions Call: Frances Smith at 835-5844
For Accounting Questions Call: Cheri Lerew 835-6196

1 - Choose the building from the list below:
Building: Room Number: Specialty gas orders must be placed by 12 noon Monday for delivery on Wednesday 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.
Other Building:  

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

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.
Enter your complete FOAP number

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?

Delivery charge is $10.00 per tank ordered - We will call you to schedule time of delivery 

Do you require empty 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)
Air Breathing Hydrogen, UHP
Air Dry, Industrial Nitrogen
Argon Nitrogen, Liquid
Argon Liquid Nitrogen, UHP
Argon, UHP Nitrous Oxide
CO2 Oxygen
CO2 w/Siphon    

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