X-Clean New Customer Sign Up Form
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
FOP Payment :
We Accept Visa MasterCard American Express Discover Card
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.