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Free Pickup & Delivery Registration Form
After you fill this form you may send it or optionally you can
print and fax
it to us. After we receive your registration our customer service representative will contact you to setup the pickup and delivery spot at your house or office and to answer any questions you may have.
Email:
You can optionally print and fax this form,
click here.
Last Name
MI
First Name
Address
Country
Zip
Home Phone
Cell Ph
Bus Ph
Company
Tell us exactly where you want your garments picked up and dropped off, most of our customers use the front door.
My Location:
Start Date:
Customer Options
Pickup/Delivery Schedule:
Twice per week
Once Per Week
On Call
Starch
Shirts
:
None
Light
Medium
Heavy
Pants:
None
Light
Medium
Heavy
FOP Payment :
We Accept
C.C#
Exp. Date
CVV2#
Billing Address
City
State
Zip Code
Name on the card
I hereby authorize X Clean Services, LLC to charge my credit card to pay for the services
I have ordered in the conditions I have agreed.
Date :
For a printer friendly version of this form click here.
