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Bensingers Home Delivery Account Application

 


Click Printer Friendly Format Button Below. Print and fax to 901-937-4805;or mail to 1856 Vanderhorn, Memphis, TN 38134  

___HOME DELIVERY/CREDIT APP   ___CREDIT APPLICATION ONLY(store charge)

PERSONAL INFORMATION:

Last Name________________________________

First Name_______________________________

Spouse’s First Name_______________________

Address_____________________________Suite/Apt#______

City ___________________ State______Zip________

Home Phone_________________ Cellphone_______________

Work Phone_________________

E-Mail Address:__________________________@_______.com

Employer ________________________________

Spouse’s Employer _______________None___

SHIRT LAUNDRY PREFERENCES:

On Hangers _____         No Starch_____            

Folded(boxed)____     Light Starch_____ Heavy Starch______

Delta Airlines® SkyMiles® #  

#__ __ __ __ -  __ __ __ -  __ __ __ 

Payment  by AmEXP,VISA® Mastercard®

 __________ -__________ -__________ - __________    ________

Visa,Mastercard,AmExp number                        Exp. Date

(may be phoned in separately)

 

Your credit card 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.

 

__________________________        ________________

Signature                         Date

__________________________________________________________________________

If you currently use a Bensinger's store, please circle one.

 

4715 Poplar      1789 Kirby Pkwy       1803 Union    

1315 Ridgeway    7580 W. Farmington    1605 Germantown@Dexter

5167 Poplar      9155 Poplar Ave       7945 Winchester@Hacks

l255 N Byhalia(collierville)