AUTHORIZATION FORM FOR TRILEX CLEANERS, INC. (must be sent in w/ all equipment---right click to print.

FIRE DEPARTMENT____________________________________________________

BILLING ADDRESS_____________________________________________________

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SHIP TO ADDRESS(write SAME for billing and shipping)

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PHONE NUMBER_________________________________________________________

FAX NUMBER__________________________________________________________________

E-MAIL________________________________________________________________

OFFICER SIGNATURE____________________________________________________________

PANT SERIAL #                                                         COAT SERIAL #

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