Name* Address* Phone Number Ticket/Receipt number Do you have your receipt? YesNo Date items brought into Dry Cleaners Return date to pick up items Describe each item in detail 1 Date Purchased 2 Date Purchased 3 Date Purchased 4 Date Purchased 5 Date Purchased Are the items listed above the entire order on your ticket? YesNo If the answer is NO, where the other items on your ticket returned to you YesNo Customer Comments Please prove you are human by selecting the Tree. Please leave this field empty.