Customer Sign-Up Form

Customer Sign-Up Form

Whether you prefer our FREE home or office pickup and delivery service or a Store Account, please fill out the form below to sign-up. Either way, we’ll be sure you get your 25% OFF “first order” discount. To inquire about your pickup and delivery schedule, or if you have any other questions, call 239.598.1555. Thank you for choosing Champion Cleaners, where you’ll look and feel like a Champion all year long!
Contact Info
* denotes a required field
Customer Name *

First Name Last Name
E-mail *
Phone Number *

Area Code Phone Number
Secondary Phone Number

Area Code Phone Number
Home Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Company Name
Company Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Authorized to charge:
Enter name(s) of individuals authorized to charge. Separate by commas.
Account Type
* denotes a required field
Account Type *

Basic Account - Store drop off & pickup only Champion Account - Delivery to your home or work
Pickup preference
Credit Card Type *
To protect your personal data, we will get your credit card number when we call you to complete your sign-up.
Name on Card *

First Name Last Name
Expiration Date *
MM/YYYY
Electronic Signature *
Date *

Month Day Year
Date Submitted
Preferences
Starch on shirts

Heavy Medium Light None
Shirt Finish

Hanger Folded/Boxed
Pants Finish

Heavy Medium Light None
Pants Crease

Crease No Crease
Garment Repairs

Yes, up to $5.00 Please call with details No
Special Instructions:
To inquire about your pickup and delivery schedule, or if you have any other questions, call (239) 598-1555.
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