ProClean Auto Wash Refund Request Form
We appreciate your patronage and our goal is to give you the finest wash and best customer service possible.  If you are not 100% satisfied with your experience at our wash please, fill out the form below so that we may process your refund request.

Please note that all credit/debit card purchases are authorized for $10.00. This amount will drop when your actual charges are posted to your bank account.
Sign in to Google to save your progress. Learn more
Title *
Mr, Mrs, Ms
First Name *
Last Name *
Phone Number *
Please include area code
Email Address *
Mailing Address *
Please include apartment or unit #
City *
State *
ZIP Code *
Date *
What was the date of your problem?
What was the approximate time of your problem?
Car Wash Location *
What is the location of the car wash you visited?
Machine Type *
Check what machine you had a problem with (you may select more than one)?
Amount Lost *
If you lost money, how much did you lose? NOTE: Credit Card Authorization of $10.00 will drop and correct charge will debit usually within 24 hours. If charged $10.00 please check statement again in 24 hours before requesting a refund.
Payment Type *
Please select from these choices
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy