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Inquiry Form

Please provide us with the following information so that we may respond to your request:

General Information

Name:

State:

Title:

Zip:

Company:

Phone:

ext:

Address:

Fax:

City:

Email:

Company Information

Pant

Industrial
Corporate casual
Dress pant

Shirt

Industrial
Polo / knit
Oxford / Dress shirt

Jacket

Ike / Industrial
Team
Parka

Lab coats

2 pocket lab coats
Smocks
Anti static / ESD

Your current program

We own
We rent
We use disposable
None

Expected soil conditions

Heavy
Light

Number of uniformed Employees:
Number of Stock inventory for Visitors:
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4352 North American Street
Philadelphia, PA 19140
phone:(215)329.8000 | toll free:(800)825.3266 | fax:(215)329.3828

e-mail:sales@cleanrental.com
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