Customer Signup Form

Champion Cleaners Customer Signup Form

To make it convenient for our customers Champion Cleaners provides a Customer Signup form. Please fill out the form below, or download it HERE and fax to 239-598-1098.

If you are interested in our Pick-Up and Delivery service for your home or office, please call 239-598-1555 to inquire about the days for your location. Any other questions, we are waiting for your call. Thank you for choosing Champion Cleaners .... We Protect Your Investment In Your Garments!

Account Information

Customer Name:

Home Address:

(Street)
(City)		(State)		(Zip)

Work Info:

(Company Name)
(Street)
(City)	(State)	(Zip)

Home Phone:

Work Phone:

Cell Phone:

Email Address:

Names of other individuals authorized to charge to this account:

PLEASE NOTE ONE OF THE FOLLOWING:

ACCOUNT ONLY (Store Drop Off/Pick Up)
ACCOUNT + PICK UP/DELIVERY HOME WORK

To qualify for monthly charge privileges and delivery, you are required to keep at least one current credit card on file. Your credit card will only be used on the day of delivery or on the first day of the following month, which ever you prefer, for automatic billing.

Credit Card Information

Credit Card:	We do not accept American Express
Name on Card:
Card Number:		Expiration Date:

Preferences

Starch on Shirts: Heavy Medium Light None Shirt Finish: Hanger Folded/Boxed
Pants Finish: Heavy Medium Light None Crease NO Crease
Repairs Up To $5.00 OK?:	YES Please Call No
Special Instructions:

Champion Cleaners will exercise the utmost care in processing garments and articles entrusted to us and use such processes, which, in our opinion, are best suited to the nature and condition of each individual article. All delicate fabrics, silks, beaded, leather, suede, and household items are cleaned according to the items written care instructions and at the owner's risk. Nevertheless, we cannot assume responsibility for inherent weaknesses of or defects in materials that are not readily apparent prior to processing. All items in the VIP Bag are subject to our intake count and are final.

I understand that by signing this application I am responsible for keeping my account current and that Champion Cleaners is authorized to process my credit card for the charges. I also understand that you will carefully process my garments and accept all conditions stated.

ELECTRONIC SIGNATURE: DATE:

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Privacy and Security

Champion Cleaners values your trust and respects your privacy. Any information that you give us is considered personal, and will be treated as such. When you sign up as a Champion Cleaners customer, be assured that the information you provide remains safe and secure. We are committed to protecting your personal data and transaction information. We do not collect any information from you beyond what is necessary to effectively process your orders, except when specifically and knowingly provided by you. Your name, address, telephone number, email address and special delivery instructions help us deliver your order. We do not sell or otherwise share your personal information with other companies.