Healthcare Laundry Accreditation Council - Certified Hygienic Testing Agreement

Company Name*

PLEASE ENTER FULL COMPANY NAME - CITY, STATE (Ex: My Healthcare Laundry Inc. - Rapid City, SD)

Current Accreditation Expiration Date:

Square Footage of Laundry Organization*

Pound Produced Monthly*

Email*

Certification Plaque*

Once certified, how would you like your laundry named on the certificate?

Expected Document Submission Date*

Invoice Email Address

Please list email address to be sent the invoice, if different than above email.