Name *

First Name

Last Name

Pickup Location *

Please let us know where to pickup your items.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

xxx-xxx-xxxx

(###)

###

####

Checkbox *

What are we picking up?

Pants

Shirt (laundered)

Shirt (Dry clean)

Women's Blouse

Dress

Skirt

2-Piece Suit

Blazer/Suit Coat

Winter Coat (short)

Winter Coat (long)

Bedspread (Queen)

Sleeping Bag

Other

Billing Address (if different from pickup address)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Acknowledgement *

By checking this box, I agree to provide full payment for all garments cleaned and serviced by Paul's Sparkle Cleaners. I understand that my pickup address, billing address and credit card information will be kept on file for future orders.