Email:
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 :
