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Hudson Technologies
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Return-Schedule Reclaim
Return-DLA Cylinders
Defective
Return-Empty Cylinders
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Schedule Reclaim Pickup
Customer Details
Company Name
*
First Name
*
Last Name
*
Title
*
Email Address
*
*
Business Phone
*
Reclaim Pickup Details
30# Empty Cylinders
*
*
HAZMAT Contact Name
*
30# Cylinders with Refrigerant
*
*
HAZMAT Contact Phone
*
50# Empty Cylinders
*
*
Number of Pallets
*
*
50# Cylinders with Refrigerant
*
Pick Up Date
*
125# Empty Cylinders
*
*
Dock Hours (Optional)
*
125# Cylinders with Refrigerant
*
Lift Gate Required?
No
Yes
240# Empty Cylinders
*
*
Need More Tags?
Need More Tags?
No
Need More Tags?
Yes
240# Cylinders with Refrigerant
*
*
Emergency Service Account Number
*
1000# Empty Cylinders
*
*
Emergency Service Phone Number
*
1000# Cylinders with Refrigerant
*
*
Pickup Address
Street 1
*
Street 2
*
City
*
State/Province
*
ZIP Code
*
Country
United States
Puerto Rico
Special Instructions
*
Customer Records
Customer
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Portal Inquiry Type
Defect or Damaged Goods
Return - Schedule Reclaim Pickup
Return - Empty Cylinders
Return - DLA Cylinders
Origin
Phone
Email
Web
Manual Entry
SharePoint
