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Customer Info

First Name:

Last Name:

Phone:

Example: (925) 123-4567

How did you find out about our service?

How do you like your laundry starched?

None Light Medium Heavy No Preference

Delivery Address

Address Line 1:

Address Line 2:

City:

State:

Billing Info (if different from above)

Company Name:

Mailing Address Line 1:

Mailing Address Line 2:

City:

State:

Zip:

Payment Preference

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Credit Card

Credit Card Info

We will charge your card end of each month for the amount serviced during that month. The billing summary will be included along with your last delivery for that month.

Credit Card Type
Credit Card Number Exp. Month Exp. Year

Special Notes

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