Bensingers Home Delivery Account Application

Fill out the form below and a representative of Bensinger's Cleaners will contact you for billing information to finalize your application.

You can also Click Here to download a printable version of the credit application to fax or mail.

Application Type         HOME DELIVERY/CREDIT APP CREDIT APPLICATION ONLY(store charge) First Name: Last Name: Spouse's First Name: Address: SUITE/APT #: City: State: SELECT ONE            Alaska        Alabama        Arkansas        Arizona        California        Colorado        Connecticut        District of Columbia        Delaware        Florida        Georgia        Hawaii        Iowa        Idaho        Illinois        Indiana        Kansas        Kentucky        Louisiana        Massachusetts        Maryland        Maine        Michigan        Minnesota        Missouri        Mississippi        Montana        North Carolina        North Dakota        Nebraska        New Hampshire        New Jersey        New Mexico        Nevada        New York        Ohio        Oklahoma        Oregon        Pennsylvania        Puerto Rico        Rhode Island        South Carolina        South Dakota        Tennessee        Texas        Utah        Virginia        Vermont        Washington        Wisconsin        West Virginia        Wyoming                Alberta        British Columbia        Manitoba        New Brunswick        Newfoundland        Northwest Territories        Nova Scotia        Nunavut        Ontario        Prince Edward Island        Quebec        Saskatchewan        Yukon Territory     Zip Code: Main Phone: Secondary Phone: Work Phone: E-mail Address: Employer: Spouse's Employer: On Hangers Folded (Boxed) Starch:         None Light Heavy If you currently use a Bensinger's store, please select one: SELECT ONE            4715 Poplar        1315 Ridgeway        5167 Poplar        1255 N Byhalia(collierville)        1789 Kirby Pkwy        7580 W. Farmington        9155 Poplar Ave        1803 Union        1605 Germantown@Dexter        7945 Winchester@Hacks None     Enter Captcha here:

You will be charged in the first week of the following month for previous months charges.

Note: Tickets on clothes picked up in previous months are billed to your credit card on first week of the following month. It is understood that this is a 30 day account. Any balance over 30 days (due to expiration or over credit limit on credit card) is considered past due and is subject to service charge of 1.5% per month on the past due balance only. If credit is granted, the above terms are deemed to be accepted. It is further agreed that if any amount due must be placed with an attorney for collection or if collection is made through bankruptcy or probate proceeedings, all court costs and a reasonable attorney's fee will be added to the total amount due.