Dry Cleaning Form - Shimmer Cleaner Services

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NAME

First *

Last*

Email Address

EMAIL ADDRESS

PHONE

Area Code*

Prefix*

Number*

Extenstion*

SERVICE ADDRESS

Number*

Street Name*

Apt/Unit/Suite*

City*

State*

Ziip/Postal Code*

Arrange for Pick-Up at:
Residence
Business
Office

Are You a Current Shimmers Cleaners Customer?
Yes
No

How Did You Hear About Us?

What is Your Starch Preference
None
Light
Medium
Heavy

Comments and/or Special Requests

BILLING ADDRESS

Number*

Street Name*

Apt/Unit/Suite*

City*

State*

Ziip/Postal Code*

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