Sign Up Form

 
   


 
Denotes a Required Field
 
First Name
Last Name
Community/Subdivision
Address
City/State/ZIP
Home Phone
Cell Phone
Email Address
Date of Birth
   
1. Cleaning
   
Shirt    Folded  
Starch
Special Instructons
   
2. Route Service
   
Days
Pick Up at
Drop Off at Front   Side Back     Other
Security Gate Number
   
3. Automatic Billing
   
Card Type
Card Number
Expiration Date
   
4. Submit Your Information
I authorize Parkway Cleaners to charge my Mastercard, VISA or American Express in accordance of said terms. I hereby certify that the information in this application is true and correct
 
Payment: For your convenience, we will charge your credit card upon completion of your dry cleaning order. We will also email an itemized monthly statement showing your credit card charges.
   
How did you hear about us?    
                  

submit    reset