Providence & Prairie Laundry Service Intake Form

Providence & Prairie Laundry Service Intake Form

Please provide your contact details and preferences below.
Full Name

First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Pickup and Delivery Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Preferred Water Temperature (I will follow care label instructions if they vary)
Would you like scent beads added to your laundry?
Select your preferred scent (if choosing scent beads)
Detergent Preference
Fabric softener
Do you have any items that need stain treatment? 1-5 Items: FREE 6-10 Items: $5 11-20 Items: $10
If yes, please describe the items and stains (optional)
Do you want your whites to be bleached
Additional needs
Should be Empty: