PICK UP & DELIVERY APPLICATION
Name:
Street:
State:
City:
Zip Code:
 Phone Number:
Email Address:
Delivery Address:
City:
 State:
Zip Code:
Phone Number:
Delivery Spot
Front Porch
Back Porch
Knock on Door
Will Leave Garage Open
Other
:
Shirts:
Starch:
Hangers
 No Starch
Light/Medium Starch
Boxed
Heavy Starch
Note:  By submitting this form you are agreeing to the
terms and conditions outlined below.
Clean Enterprises
315 W. State Street
P. O. Box 664
Quarryville, PA 17566
(717) 786-2643
(877) 379-5533 TOLL FREE
cleanenterprises@epix.net
                                                 Terms & Conditions
  1. All Charges due and payable in full upon receipt of statement each month.
  2. Holder(s) of account accept full responsibility for all charges made to this account, according to the  
    instructions set forth above. Instructions may be changed by providing written notice to Clean Enterprises but
    will be recognized only upon receipt of signed notice.
  3. When one holder of a joint account wishes to cancel joint status, signed instructions must be submitted to
    Clean Enterprises. Upon receipt of such instructions from either party, the joint account will be cancelled. A
    separate account then may be opened by both parties pursuant to their good credit standing and upon
    written application for an individual account.
  4. Holder(s) of this account agree to pay all collection or legal fees required to collect payment on delinquent
    accounts.
  5. Submission of this credit application authorizes Clean Enterprises to verify all information provided by
    applicant(s).
  6. 18% annual finance charge on past due accounts.