First Name: Last Name:

Home Address:

City: State:  Zip:

Home Phone:-- Work Phone:--

Please Check Your Preferences:

Hangers Boxed      Starch: Light Medium Heavy None

Special Instructions For Clothes:

Special Instructions For Pickup/Delivery Person:

                                            BILLING INFORMATION

Driver's License# SSN# --

Employer:

Employer's Address:

City: State: Zip:

Please Check:   MasterCard  Visa  #---

Bank:

Name On Card:

First: MI: Last:

                                  Exp. Date: //