Helium Rental form
Be advised that all field with thered star *are required, to submit this form successfully.
Section 2 & 3 are for long term Rental Customers Only
credit card authorization form
Download the credit card authorization form file on the right by clicking on the image icon PDF doc, print it and fill up all the required fields on the form with your information, sign it and send it back to us by upload it, email or fax. This step is for long term rental customers that need our service for helium.
Upload files only in the formats as listed below
Send a COpy Of Your Government State ID Card
Upload or email us a copy of your state government ID card make a photo copy of the front and back.