Adjustment Form

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