Frances Smith at
Cheri Lerew 835-6196
What type and quantity of gas do you require?
Enter a quantity for each type of gas you require
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
250 Characters Max.
Would you like to be called about this Gas order?