Service Request Form

15 April 2013, Comments: 0

Service Request Form

Please note that All Requests must be submitted via, in person, fax or email (preferred). ALL Requests for delivery MUST be accompanied with a detailed map of the pickup/delivery location to implement service. Maps should be as detailed as possible and contain familiar landmarks to reference. It is the customer`s responsibility to notify of any PPE required to access delivery locations. Please allow 3 - 5 business days to complete Requests.

Company Name:
Customer #:
Contact Name:
 Cleaning Services Mat Rental Coverall Rental Other Specify:
Frequency:  Weekly 2x/Wk 3x/Wk 5x/Wk 7x/Wk Bi- Weekly Monthly Call-In Other

If other please specify:
Preferred Days:  Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Repairs Required:  Yes No
PPE Required for delivery Location:  Yes No Specify:

Note: Unless garment inventory tracking sheet is provided, COVERALL`s Count Must be deemed as Accurate


Accounts Payable Contact Information
Ph: (780) 791-0766 Email: Fax: (780) 743-4314