SmartLockerz Registration Form Name* First Last Mobile Phone for texting *standard data fees and text messaging rates may apply based on your plan with your mobile phone carrier.Alternative Phone NumberEmail* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Have SmartLockerz Representive Call me for CC information Credit card number I, the undersigned am an authorized signer of the credit card detailed above. I authorize J MIN, INC. dba Natural Cleaners to use the credit card information above to pay any invoices for my account. I will be provided a copy of my receipt upon request. Applicant accepts full responsibility for all charges made to this account. Choose a 4-digit Pin NumberPlease enter a number from 0000 to 9999.Expiration date (00/0000) 3 digit code on back Signature*I/We agree to all terms and conditions set forth above