Name
First Name
Last Name
Spouses Name
Address
City, State, ZIP
E-mail
Phone Number
-
Area Code
Phone Number
Preferred Pick-Up/Delivery Location
(Sheltered from weather is best) Front Door, Side Door, Inside Garage, Inside Proch, Other (specify).
Laundered Shirt Starch Preference
None
Light
Medium
Heavy
Laundered Shirts
Hangers
Folded
Repairs
Automatically Repair Buttons, Hems, Seams
Call Me
Credit Card Info
American Express
Discover
Mastercard
Visa
Credit Card Number
Expiration Date
Additional Info
How Did You Hear About Us?
Existing Customer
Direct Mail
Referral
Internet Search
Facebook
Other
Submit
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