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This cylinder deposit agreement is by and between Pure Chem Separation, LP (PCS) and * hereafter referred to as Customer.)

PCS provides cylinders for use in its Pure Chem refrigerant buy back program. The cylinders are the property of PCS and are to be used by Customer only for the purpose of returning R-22 or other acceptable refrigerants back to PCS. Any other use is prohibited.
As a program participant, Customer hereby agrees to return the cylinder according to the Terms of the refrigerant buy back program. The Terms are the prevailing price, purity schedule and minimum weight requirements outlined in the contractor page.
PCS will pay freight on cylinder shipments as long as they contain the minimum weight of refrigerant. Customer agrees to pay freight if cylinders do not have at least 900 lbs. or more refrigerant for a 1000 lb. cylinder and at least 200 lb. or more refrigerant for a 240 lb. cylinder.
The cylinder deposit will be refunded upon final return of the cylinder assuming it is in good condition. The deposit will stay with PCS as long as customer is a program participant.
PCS will provide full payment of cylinders within 30 days from receipt. Payment is based on net weight of actual refrigerant and the prevailing Pure Chem buy back price of refrigerant.
Customer agrees to pay $2.50/lb. for disposal fee if refrigerant is below 60% purity level.
PCS will provide a receiving report for your EPA records showing the weight of refrigerants reclaimed and the purity level.

Contact Information

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Billing Address

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Shipping Address

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Is there an available forklift or loading dock on site?	Yes No
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Size of R-22 Cylinder	Deposit Each	Quantity	Subtotal
240 lb.	$250.00
1000 lb.	$750.00
Total Deposit:

Deposit Payment Information

How will you pay for your total today?

I will mail a check. Mail to: Pure Chem Separation 11050 So. Hwy 287 Rhome, TX 76078. I will pay by credit card. Call (817) 636-2089 with information.

I understand that by submitting this form, this does not complete my transaction. I will pay the total amount due via one of the payment options I selected above.