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 NameLast Name
E-mail*
Phone Number*

Area CodePhone Number
Secondary Phone Number

Area CodePhone Number
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Company Name
Company Address

Street Address

Street Address Line 2

CityState / 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 onlyChampion 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 NameLast Name
Expiration Date*
MM/YYYY
Electronic Signature*
Date*

MonthDayYear
Date Submitted
Preferences
Starch on shirts

HeavyMediumLightNone
Shirt Finish

HangerFolded/Boxed
Pants Finish

HeavyMediumLightNone
Pants Crease

CreaseNo Crease
Garment Repairs

Yes, up to $5.00Please call with detailsNo
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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