ATS Eagle Canyon

Customer Registration Form

sales@ats-eaglecanyon.com

ats-eaglecanyon.com

Form ref: ATS-REG-01

Complete this form to register as a customer for LPG cylinder deliveries and PUDO locker collections at Eagle Canyon Estate. Please print clearly in block letters. Return the completed form to any ATS driver, drop it in the PUDO locker, or WhatsApp a photo to our orders line.

1. Customer details

Full name

WhatsApp mobile (e.g. 082 123 4567)

Alternate contact number

Email address

Estate / complex

Stand / unit number

Street address

Gate / access code (optional)

2. Cylinder preferences

Cylinder size

9 kg

19 kg

48 kg

Cylinder type

Steel (with trade-in / swop)

Steel (new — pay deposit)

Composite (lightweight)

Typical quantity per order

Preferred delivery day / time

Notes (colour of cylinder, brand, condition, etc.)

3. Fulfilment preference

Home delivery to address above

PUDO locker collection at Eagle Canyon

4. Preferred payment method

Paystack (online card)

EFT / bank transfer

Cash on delivery

Card on delivery (portable machine)

5. Consent & declaration

WhatsApp updates: I agree to receive order confirmations, PINs, and delivery updates via WhatsApp.

Marketing: I agree to receive occasional promotions from ATS Eagle Canyon (optional).

POPIA: I consent to Ezigas Pty Ltd processing my personal information for the purpose of fulfilling gas orders, in line with the privacy policy at ats-eaglecanyon.com/privacy.

Signature

Date

Office use only

Captured by

Date captured

Customer ID

Site

Notes

Verified by

Date verified

Return to any ATS driver · drop at the Eagle Canyon PUDO locker · or WhatsApp a photo to our orders line. · Ezigas Pty Ltd · sales@ats-eaglecanyon.com