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    Name *
    Address *
    Phone Number *
    E-mail *
    Pick-Up Date
    Pick Up Time
    Delivery Date
    Delivery Time
    Preferred Laundry Detergent
    TideGainAll Free & ClearI Will Provide
    Bleach Whites
    YesNo
    Laundry Bag Needed?
    YesNo
    Line Dry Items Included (Limit 5 Items)
    Special Instructions *