NOTE: This form is provided for your convenience only. You are not required to fill out this form on each order.
 
 
 
Name: Phone No: Email:
Date To be picked up (route day) or dropped off at store
 
 
My item is Material is primarily Color of article is
 
 
Location of stain Stain is
 
  If you've tried to remove the stain, please let us know what you did:  
   
  Notes