|
|
Student Information:
|
|
|
 |
|
|
|
|
First Name:
|
|
|
|
|
|
|
|
|
|
Last Name:
|
|
|
|
|
|
|
Your email address:
|
|
|
|
|
|
|
|
Your phone
number (where we
can contact you)
|
|
|
|
|
|
|
|
|
|
Billing Information:
|
|
|
Name of Contact
|
|
|
|
|
|
|
|
Parent/Home Email
|
|
|
|
|
|
|
|
Billing Address 1:
|
|
|
|
|
|
|
|
Billing Address 2:
|
|
|
|
|
|
|
|
City
|
|
|
|
|
|
|
|
State
|
|
|
|
|
|
|
|
Zip
|
|
|
|
|
|
|
|
Our low semester price:
11 Bags
(a laundry bag is provided at sign-up)
$160
OR
3 Bags/mo.
$45
|
|
|
|
 |
|
|
|
|
|
Payment Options
|
|
We accept Visa, MasterCard, Discover or Check (If paying by check,
please include credit card info for overage and/or dry cleaning billing)
|
|
|
|
|
|
|
|
|
Name of Cardholder
|
|
|
|
|
|
|
Credit Card Number
|
|
|
|
|
|
|
|
|
|
|
Expiration Date
|
|
|
|
|
|
|
Credit Card: I agree to pay above total amount according to card issuer agreement. All laundry
turned in to Sam’s Cleaner at Lake Road Laundromat by an authorized user of that account will be
cleaned and any extra pound charges and dry cleaning charges will be added directly to this
account.
|
|
|
|
Liability Disclaimer: Sam’s Cleaner is not responsible for your laundry items bleeding, shrinking,
fading, or otherwise becoming altered or worn by the normal wash-and-dry laundry process. We
will take reasonable precautions against known problems. You agree that Sam’s Cleaner may
refuse to launder an item and send it back unwashed with an explanatory note, if we think it will
become damaged or damage other items. Sam’s Cleaner assumes no responsibility for items
labeled HAND WASH ONLY, HANG DRY/DRY FLAT, DO NOT USE HEAT, DRY CLEAN ONLY, or other
“special care” instructions.
|
|
|
|
Spring Semester
|
|
I would like my laundry plan to automatically
renew for the Spring 2012 semester.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
