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RESIDENTIAL PICK-UP & DELIVERY FORM:
* Required fields
Name *
E-mail Address *
Street Address *
Unit #
Phone # *
Pick-up Month *
January
February
March
April
May
June
July
August
September
October
November
December
Pick-up Day *
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Preferred Pick-up Time *
06:00
06:15
06:30
06:45
07:00
07:15
07:30
07:45
08:00
08:15
08:30
08:45
09:00
09:15
09:30
09:45
10:00
10:15
10:30
10:45
11:00
11:15
11:30
11:45
12:00
12:15
12:30
12:45
13:00
13:15
13:30
13:45
14:00
14:15
14:30
14:45
15:00
15:15
15:30
15:45
16:00
16:15
16:30
16:45
17:00
17:15
17:30
17:45
18:00
18:15
18:30
18:45
19:00
19:15
19:30
19:45
20:00
20:15
20:30
20:45
21:00
21:15
21:30
21:45
22:00
22:15
22:30
22:45
23:00
Delivery Month *
January
February
March
April
May
June
July
August
September
October
November
December
Delivery Day *
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Preferred Delivery Time *
05:00
05:15
05:30
05:45
06:00
06:15
06:30
06:45
07:00
07:15
07:30
07:45
08:00
08:15
08:30
08:45
09:00
09:15
09:30
09:45
10:00
10:15
10:30
10:45
11:00
11:15
11:30
11:45
12:00
12:15
12:30
12:45
13:00
13:15
13:30
13:45
14:00
14:15
14:30
14:45
15:00
15:15
15:30
15:45
16:00
16:15
16:30
16:45
17:00
17:15
17:30
17:45
18:00
18:15
18:30
18:45
19:00
19:15
19:30
19:45
20:00
20:15
20:30
20:45
21:00
21:15
21:30
21:45
22:00
22:15
22:30
22:45
23:00
Scented or Unscented Soap *
Scented
Unscented
This laundry is *
Personal
Commercial
Type of Laundry *
Clothing
Bedding/Linens/Towels
Blankets/Comforters/Duvets
Mix
Other
Quantity of Laundry *
Up to 30 pounds, or one large item
30 pounds or more, or multiple large items
Any Wash/Dry Preferences?
Preferred payment method *
Credit Card
Interac e-Transfer
I have read and agree to the
Privacy Policy
*
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