A-Gas Drop-a-JUG™ Registration Form to Become a Drop-Off Location

Contact Details

First Name *

Last Name *

Business Name *

E-Mail *

Contact Number *

Site address where the Drop-a-JUG™ crate will be located

Street Address 1 *

Street Address 2

Suburb *

Post Code *

Comments

Consent for storing submitted data *

Yes, I give permission to store and process my data

Terms and conditions *

By submitting this form, you acknowledge that Drop-a-JUG™ collection crates belong to A-Gas and commit to ensuring that only non-flammable disposable refrigerant cylinders are deposited as per our provided instructions. A-Gas shall not be liable for any direct, indirect, incidental, special, or consequential damages arising out of or relating to the placement of its assets on your site, including but not limited to damages for loss of profits and business interruption.

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