
	Name:
	Occupation:
	Email:
	Address:
	City:
	State:
	Zip:
	Phone:
	Current Dry Cleaner:
How did you find your cleaners?		Phone Book Referral In neighborhood Other:
Do you use coupons?		yes no
Where do you get your coupons?		Newspapers Phone book Mail On the order Other:
Do you wear uniforms or lab coats at work?		yes no

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