Express Valet Dry Cleaning Service

266-2075

Sign Up Information Sheet

First Name_________________________

Last Name_________________________

Home Address ______________________

__________________________________

City          _________________________

Zip Code  _________________________

Home Phone _______________________

(For our use only, in case we have a question about your cleaning)

*Place of Work _________________________

Work Phone__________________ Ext._____

Email     ______________________________

Please circle one

Credit Card-    Master Card    Visa    Discover  

Account Number________________________________

Expiration Date _________________________________

Billing Address For Card - Street Number_____________

                                        - Zip Code__________________

I authorize Express Valet Dry Cleaning Service to bill my credit/debit card for payment of dry cleaning and laundry services provided to me.

File Signature   __________________________________

Thank You!  Email Bill Hypes at- expressvalet1@aol.com