My Drycleaner

Account Wrapper

Customer Information :

Customer Information

Service Type

Retail Store Home/Office Delivery

Title

*First Name

*Last Name

* Email Address

* Retype Email Address

* Password

(4-30 characters. Requires 3 of the 4 classes: upper case alpha, lower case alpha, numeric, special characters)

* Retype Password

(must match exactly)

Referral Source

* Birthday

Address (click for more addresses)

* Address 1

Address 2

* City

* State

* Post code

#####, #####-####

Delivery Address
Delivery AddressSame as primary address
Address 1
Address 2
City
State
Post code	#####, #####-####

Billing Address
Billing AddressSame as primary address
* Address 1
Address 2
* City
* State
* Post code	#####, #####-####

Phones

Home

Ext.

(Please space correctly) more

Cell

Ext.

Business

Ext.

Other

Ext.

Available Options

Notify Me With

	On Batch Emails Sent
	On Delivery Notification
	When Report Email Presentation
	When Route Orders are Detailed
	On Route Reminder
	Coupons, Promotions or Specials

Credit Card (click for more credit cards) (required)

*Credit Card Number

(Numbers Only, No Spaces)

* Exp.

(MM/YY)

Credit Card Entry

Second CC Number	(Numbers Only, No Spaces)
Exp.	(MM/YY)
Start Date:	(MM/YY)
Issue:	(0, 1 or 2 digits)

Preferences

Laundry Shirts Starch:

Comments

0/250

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Version: 6.1.167.0