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New Customer Registration

If you'd like regular 45kg gas bottles delivered to your home, please complete the registration form below.

If you'd like an initial quote, please get in touch or call us on 022 454 2891.

Personal Details
First Name
Last Name

Delivery Address (Delivery price varies based on the delivery location.)

Street Address
Street Address 2
City	Region
Postal Code	Country

Is your delivery address the same as your postal address?

Yes
No

Postal Address

Street Address
Street Address 2
City	Region
Postal Code	Country

Contact Number
Email
Next of Kin / Contact Person
Landlord's details
Drivers Licence Number
Drivers Licence Version Number
Date of Birth
Day - Month - Year
Pricing
Number of Cylinders
Size of Cylinders
Supply Agreement
SUPPLY AGREEMENT

Rental $56 per bottle per annum
Initial Delivery Date
Day - Month - Year
What do you use LPG for?

Heating
Cooking
Hot Water
Grain Dryer
Additional Information
Do we require a key for access?

Yes
No
Do you have a dog?

Yes
No
Specific Requirements (access, conditions etc)
Declaration

I have read and agree to the Terms and Conditions*
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Captcha

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Call 022 454 2891

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