Route Form
Name:
Address:
City/State/Zip:
Home Phone:
Business Phone:
Cell Phone:
Others Authorized To
Use Your Account:
Name On Credit Card:
Billing Address:
City/State/Zip:
Credit Card Number:
Expiration Date:
MINIMUM MONTHLY CHARGE AMOUNTS/SERVICE CHARGE.
Charge accounts running less than $150.00 per month are subject to a $20.00 SERVICE CHARGE per month. If that is not acceptable, you may use you credit or debit card at the point of pick-up, and we will swipe it each time you pick up your order, or you may pay by cash or check.
STATEMENTS WILL ONLY BE SENT BY E-MAIL!!
ALL applications must be COMPLETELY filled out.
Your cleaning services may be paid for by one of the two methods:
Charge to your VISA or MASTERCARD
WE WILL NOT TAKE AMERICAN EXPRESS OR DISCOVER CARDS.
Debit or charge will occur AS DELIVERIES ARE MADE.
If you do not want to submit this form online you may e-mail us at [email protected], call us at (214) 361-0557 and we will fax you a form, or come in during business hours.
