Membership Inquiry Form
Please fill out COMPLETE and ACCURATE information.
Customer First Name
Your answer
Customer Last Name
Your answer
Best Phone Number to Contact for questions:
Please label home or cell
Your answer
Email Address
Your answer
Unlimited Monthly Membership Type
Membership #
This can be found on the bar code attached to your vehicle, if you don't know just th # sign. If you have multiple, use a comma to seperate.
Your answer
License Plate #:
Your answer
Membership Request?
Vehicle Type?
Please write any details if needed regarding the above request:
Your answer
If CANCELLING membership please check all that apply?
Comments on why CANCELLING:
(Please help us to improve)
Your answer
Would consider purchasing an unlimited membership in the future?
Will you be coming back to our wash but just not as a member?
Any other general comments or concerns?
Your answer
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