Today's date :
Name:
Address:
Nearest cross street:
Phone:
Home:
Work:
Cell:
Fax:
Email:
Start date:
Pick up and delivery days:
Monday & Thursday
Monday only
Thursday only
Will call
Would you like your shirt:
On hangers
Or folded
With:
No Starch
Light Starch
Medium Starch
Heavy Starch
Where will we pick up and
deliver you cleaning?
Ex. door knocker, in garage(key code) breezeway, on provided hook, etc.
Please provide your Credit Card information below
or call us at 203-792-7400 to provide your information.
What is your preferred
method of payment?
Mastercard
Visa
Card Number:
Expiration date:
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