Propane Cylinder Pickup & Payment Form

Propane Cylinder Pickup & Payment Form

Please provide your details and payment information to schedule your cylinder pickup and filling. Preferred pickup date is subject to driver availability. Please make sure the cylinder is accessible by the pickup date requested. If you'd like to purchase a new cylinder, please call for pricing and availability.
Full Name

First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Pick-Up Address

Street Address

Street Address Line 2
CityState / Province
Zip Code
Description of where you are leaving the empty propane cylinder at the pickup address
Preferred Pick-Up Date

MonthDayYear
Date
Additional Information

Triumph Industrial Supply is located at 55 W. Main, Baytown, TX 77520. We currently service zip codes 77520, 77521, and 77523. Please check back for future expanded service area. You will be contacted if your cylinder has expired. Most cylinders are good for 12 years after the manufacture date, which is stamped on the collar of the cylinder.
I've read the additional information and understand that expired or damaged cylinders will not be filled (Initial below)
Payment - Cylinder Information
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20# Propane Cylinder
Pick-up and refill of my 20# propane cylinder.

$25.00 Quantity



30# Propane Cylinder
Pick-up and refill my 30# propane cylinder.

$35.00 Quantity



33.5# Forklift Cylinder
Pick-up and refill my 33.5# forklift cylinder.

$39.00 Quantity



40# Propane Cylinder
Pick-up and refill my 40# propane cylinder.

$43.50 Quantity



100# Propane Cylinder
Pick-up and refill my 100# propane cylinder.

$99.00 Quantity



Total

$0.00
I authorize my credit card to be charged for the total listed above.

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty:

Propane Cylinder Pickup & Payment Form

Additional Information

Payment - Cylinder Information*

Payment Methods

Payment - Cylinder Information