Minit Car Wash

Unlimited Wash Pass Application

Personal Information

First Name: _________________________  Last Name: _________________________

Address:__________________________________________________________________

City/Town: _________________________ State: ____________ Zip code: __________

Telephone Number: _________________________

E-Mail Address:____________________________________________________________

Vehicle Information

Vehicle Make:_________________________ Vehicle Model: ______________________

Vehicle Year:_________________________ Vehicle Color: _______________________

License Plate (Number & State): ____________________________

Choose A Plan

Check One

 ___ Basic Wash Pass - - - $29.99/Month

 ___ Gold Wash Pass - - - $39.99/Month

 ___ Platinum Wash Pass - - - $49.99/Month

 ___ Ultimate Wash Pass - - - $59.99/Month

By Signing Below You Acknowledge That You Have Read And Understand The Terms & Conditions Associated With Your Chosen Plan.

Signature:______________________________

 *After Form Is Completed Please Present It To Us At Your Next Visit To Finalize Your Application. 

   Do Not Include Any Credit Card Information On This Form.  All Credit Card Processing Will Be Done On Location.