Cylinder Collection & Deposit Return Form

Returning your unrequired empty gas cylinders?

Complete this form to arrange collection and receive your deposit refund.
Refunds are made by bank transfer within 5–7 working days after collection and verification.

🔒 Your details are stored securely and used only for processing your refund. This form complies with UK GDPR regulations.
Name*

First NameLast Name
Cylinder Collection Address*

Street Address

Street Address Line 2

CityState / Province

Post Code
Email*
example@example.com
Contact Mobile Number*
Original Deposit Paid Date or Order Number (if known)
If you’re not sure, leave this blank — we’ll locate your record from our system.

Cylinder(s) being returned*

Preferred Collection Date*

DayMonthYear
Date
Deposit Refund Details

Please enter your bank details for your deposit refund. Your data is encrypted and accessible only to authorised staff
Account Holder Name*
Sort Code*
Account Number*
Declaration and Consent
✅ I confirm that:

• The information I have provided is accurate.
• I am the account holder and authorised to receive the refund.
• I understand that Eastern Gases Ltd will use my details only to process the deposit return in accordance with GDPR.

🔒 Your data will be stored securely and deleted after your refund has been processed.
Confirmation*

I agree to the above and consent to Eastern Gases Ltd processing my details for deposit return purposes.
Please verify that you are human*
Should be Empty:

Deposit Refund Details