From:______________________________

     ______________________________

     ______________________________

CORONET LEATHER CLEANERS
 
3358 YORK STREET

DENVER, COLORADO 80205

(tear here - use as your shipping label to us) 
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Your Name_____________________________________________

Address_______________________________________________

City, State, Zip______________________________________

Area code & phone____________________________________

E-Mail address________________________________________

[] Check  [] MC  [] Visa  Card#__________________________________ Exp.______

Do you wish to purchase return shipping insurance?  $100.00 is automatically
included.  Yes_______   No______  Amount requested___________.  Extra
insurance is 1% of your declared value.

We will call or e-mail you when shipment is received.

List the garments you are sending and circle what you would like to have done. 

_________________________      Clean     Repellent     Redye     Repair
                          Comments: 

_________________________      Clean     Repellent     Redye     Repair 
                          Comments: 

_________________________       Clean     Repellent     Redye     Repair 
                          Comments: 

(tear here - put this portion in box with your articles) 
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You have sent your garments to: 

Coronet Leather Cleaners
3358 York Street
Denver, Colorado 80205
303-297-0306 FAX 303-297-0307
Harry@CoronetLeather.com

(keep this for your records until the garments are returned)
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