MAIL-ORDER TxO2 REFILL BY GT&S

MAIL-ORDER TxO2 REFILL & SERVICING By GT&S

Return empty TxO2 emergency oxygen unit in its original shipping carton
with foam padding (or equivalent packing) via UPS, Fed Ex, DHL or US Mail.

Mail to:

GT&S Inc.

5275 Tilghman Street

Allentown, Pa 18104

Be sure to remove mask train assembly and retain.
Be sure to remove or cover the Hazmat yellow and green diamond label on the carton.
Be sure to send portable pin (white pin on chain) with the unit, otherwise there will be a charge for a
new pin.

Filled TxO2 unit will be shipped via UPS Ground ONLY within 3 working days.

Note: If the cylinder requires its 5 year hydrostatic test add 5 days. Return information should include:

Customer Name: ____________________________________________________________________

Attention: ___________________________________________________________________________

Address: ___________________________________________________________________________

____________________________________________________________________________________

Phone#: ____________________________________________________________________________

Basic Pricing as of Jan 2004 (subject to change):

Fill Charge: $17.00

UPS Shipping Charge: Actual according to current UPS rates.

UPS Hazmat Charge: $20.00

Payment Circle One: Visa MasterCard American Express

Note: We only accept Credit Cards for mail order refills & service.

Card Information:

Name: ____________________________________________________________

Card#: ____________________________________________________________

Exp Date: __________________________________________________________

Additional pricing when applicable:

Portable Pin (if not returned with empty unit) - $ 8.50

Hydrostatic Testing (when due) - $15.50

Shipping & Handling - $5.00

Burst Plug Replacement - $5.00

If any additional charges are necessary you will be contacted before work is done.

Policy

Occasionally returned TxO2 units may not be in a refillable condition (e.g. shipping damage). GT&S Inc. will notify the contact person and return the unit unaltered for the cost of shipping only. No Hazmat charge applies to empty TxO2 units.