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| *First Name: |
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| *Last Name: |
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* Daytime Phone:
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* Evening Phone:
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| * Delivery Address: |
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| * City: |
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TN |
| * Zip Code: |
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Home Address:
If different from Above |
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| City: |
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| State or Region: |
TN |
| Zip Code: |
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* Email
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How Did You Hear About Our Service?:
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Would you like email reminders before your pickup days?:
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* What type of starch do you prefer?:
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In the box below please list any questions
or comments that you may have.
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I understand that Executive Cleaners LLC will create an account in my name and charge my cleaning services to this account; Executive Cleaners LLC will bill me monthly for this account. I agree to pay the charges on this account in full within 30 days of the statement date. If any action for collection is initiated, I agree to pay all costs and attorney fees associated with the collection of this account.
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I Agree |
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