HETRA Blanket Services Intake Form
Contact Information
First Name
Last Name
Phone Number
Email
Address
City
Zip code
Blanket #1
Color and Brand and Size
Blanket Category
Please select...
Sheet/Slinky ($10)
Medium Weight ($15)
Heavy Weight ($20)
Light Soil or Heavy Soil
Please select...
Heavy ($10 extra charge)
Light
Would you like your blanket waterproofed?
Yes ($5)
No
Number of rips/tears (under one inch)
Blanket #2
Color and Brand and size
Blanket Category
Please select...
Sheet/Slinky ($10)
Medium Weight ($15)
Heavy Weight ($20)
Light Soil or Heavy Soil
Please select...
Heavy ($10 extra charge)
Light
Would you like your blanket waterproofed?
Yes ($5)
No
Number of rips/tears (under one inch)
Blanket #3
Color and Brand and Size
Blanket Category
Please select...
Sheet/Slinky ($10)
Medium Weight ($15)
Heavy Weight ($20)
Light Soil or Heavy Soil
Please select...
Heavy ($10 extra charge)
Light
Would you like your blanket waterproofed?
Yes ($5)
No
Number of rips/tears (under one inch)
Total Due
Please understand we don't take blankets with large tears (over one inch). We do not take responsibility for further damage which could occur to a blanket that has tears of any type.
I Understand
Drop off is by appointment only. Please wait for a confirmation email or phone call to determine drop off date/time as well as pick up date and time. Please call us at 402-359-8830 for questions.
Preferred Drop off date
Preferred Drop Off Time
Preferred Pick up date
Preferred Pick Up Time
Comments:
Signature
Payment Information
Name on Card
Card Number
MM
YY
Code
Billing Email
Contact Information