LloydsCleaners.com - Pickup/Delivery Signup Form

Lloyds Cleaners | Mr. Dry Cleaners

Customer Information
(All information is strictly for the use of billing for cleaning service.)
On or after what date would you like the pickup/delivery service to start?

MonthDayYear
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
E-mail*
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
PICK-UP/DROP-OFF
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Employer
Daytime Phone

Area CodePhone Number
Daytime Phone Extension #
(Daytime phone used only if pland has questions regarding clothing)

Cleaning Preferences
Shirts*

On HangerFolded/Boxed
Starch*

HeavyMediumLightNone
Where will the cloths be left to pick up?*
Where should the cloths be left when delivered?*
Special Circumstances (Check all that apply)

SprinklerDogAlarmGateHousekeeperOther
If Housekeeper, what days/times will they be there?*
If other, please explain*
Directions: please provide closest road or intersection*
AUTO BILLING
Credit Card #
Credit Card Type*

VisaMastercardAMEXDiscover
Credit Card Expiration Month/Year*
By completing and submitting this online form, you agree to to authorize Lloyds Cleaners/Mr. Dry Cleaners to keep your credit card information on file and to bill you.

You also agree to notify Lloyds Cleaners/Mr. Dry Cleaners immediatly of any changes to either the expiration date or card number doe to loss, expiration, or your desire to have billing directed to a different card.
Signature*

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