BILLING INFORMATION (as associated with credit card you intend to use for billing):
Name
(as it appears on card):
Billing Address 1:
Billing Address 2:
City:
State:
Zip:
Email address:
Phone number:
CLEANING PREFERENCES:
Starch:
Special Instructions:
ex:  "I never want center
creases on my slacks".
A pureGreen REPRESENTATIVE WILL CONTACT YOU SHORTLY TO CONFIRM YOUR ACCOUNT SETUP
AND PAYMENT METHOD.
Set-up my pureConvenience Account
Enter your cleaning preferences and billing information below to establish your
pureConvenience account.  Just leave your order for us on a regularly scheduled route day
and it's automatically billed to your credit card on file.  You receive a receipt with each order.  
If you aren't on a regularly scheduled route, click here to join a pureGreen route...no cost, no
commitment.
Don't want to log on for each order?
  A pureConvenience account lets you leave it and go!