Request For Service     

   To schedule our door-to-door service on-line, please type in your information in the fields provided, and click on Submit.

   A PCG customer service representative will contact you within one business day to confirm your request, and arrange for a convenient pick up date and time.

Full Name:
Street:
Unit: (if applicable)
City:
Province:
Postal Code:
Phone: (include area code)
Business Phone: (include area code)
Fax:
Email:
Comments:
Please answer the following questions:
1. How did you hear about ProCleanGear?
Newspaper Television Flyer  Retail Outlet
Arena Internet Search Friend Other
2. Rate the importance of the following:
a) Fresh Smell
   Not at all    Not Very    Somewhat    Very    Crucial
b) Clean & Sanitized
   Not at all    Not Very    Somewhat    Very    Crucial
c) Increased Life-span
   Not at all    Not Very    Somewhat    Very    Crucial
Please indicate a preferred time for our service representative to pick up you equipment:
Day:    Month:    Year: 20    Time:

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www.procleangear.com