Delivery Sign-Up Form

H₂Only Cleaners

green dry cleaning Wedding Gowns 1 Suede and Leather 1 Dry Cleaning 3

Free* Pick-Up and Delivery

Application

NOTE: This form is not to be considered secure. No confidential information will be taken.

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Your information will be received properly despite this issue.

Alternatively, you may call 598-0583 To Initiate Service.

*Effective Jan 10, 2011: Delivery orders totaling less than $15.00 will have a $1.00 fuel surcharge added.

Please provide the following information:
Name

Street Address

Address (cont.)

City

Zip/Postal Code

Day Phone

Evening Phone

E-mail
Frequency:
Shirts:
Pants:
Sweaters:

Enter your special instructions in the space provided below:
If An H₂Only Cleaners Customer Referred You Please Enter Their Name:

We will call you within 24 Hours To Complete Your Delivery Setup.
We require a credit card on file for delivery customers. Orders are charged before delivery.
In order to save fuel and further reduce truck emissions, weekly and twice weekly customer will have their status changed to "call as needed" if they have not submitted an order for pick up in 2 weeks. To request to return to regular pick-up status call the main store at 598-0583.

NOTE: H2Only Cleaners cannot be held responsible for loss or damage, including theft or weather related damage, prior to pick-up or after delivery, of items.
Weather delays may delay your order by one cycle. You may pick up your order at the Brier Creek store prior to your next delivery if you like, by calling 598-0583 at least 24 Hrs in advance.

Copyright © 2006 H2Only Cleaners. All rights reserved.
Revised: 09/18/05