X-Clean New Customer Sign Up Form
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
Country Zip
Home Phone
Cell Ph
Bus Ph
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
Shirts: None Light Medium Heavy
Pants: None Light Medium Heavy
  For a printer friendly version of this form click here.