Pickup & Delivery Request
Become A New Customer
Coupons & Specials
Read About Our Services
 

New Customer Form

PERSONAL INFORMATION:
Name:


Business Name:


Business Address:


City & State:


Zip Code:


Home Mailing Address:


City & State:


Zip Code:


E-Mail:


Home Phone:


Work Phone:


Fax Number:


Other Contact Phone or Pager:




BILLING INFORMATION:
Type of credit card:



Name on Card:


Credit Card Number:


Expiration Date:


I here by authorize Soma Cleaners to bill my credit card monthly for services provided. I understand that I will receive an invoice each time I receive my cleaning and that I will receive a monthly billing statement so that I can verufy the charges.

Sign by typing your INITIALS:

 

 
---