What type of service are you looking for? (Check One) A One Time Cleaning A Regular Service 1 2 3 4 5 6 7 8 9 10 11 12 Week(s) A Spring Cleaning A Move-In / Move-Out Cleaning Other Cleaning (Please Describe)
Would you like any additional services? (Check All Applicable) Laundry Inside Refrigerator Inside of the Cabinets and Drawers Wiped Down Inside of the Oven Baseboards Wiped Down Inside of the Windows or Blinds Cleaned ? How many Windows 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 How many Blinds 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 How Many Bedrooms? 1 2 3 4 5 6 7 8 9 10 11 12 How Many Bathrooms? 1 2 3 4 5 6 Half Baths? 1 2 3 4 5 6 Preferred Day of Week Monday Tuesday Wednesday Thursday Friday Saturday How many hours do you need a cleaner? Do you have any special requests?
Are there any special products that You will provide for us to use? Yes No If so, Explain
TELL US ABOUT YOUR HOME In what Area of town or city are you located? What is the approximate square footage of your home? Is it a House Apartment/Condo Townhome How many floors? 1 2 3 4 How would you rate the condition of the home? Excellent Good Fair Poor Last time cleaned by you or a professional cleaning service?
In addition to Living Room and Dining Room, what additional rooms would you like us to clean? Office Family Room Play Room Den Would you like them Dry Dusted? (Recommended) Would you like them Damp Mopped Are there any Special Finishes in the home such as: Granite Brass Marble Other
TELL US ABOUT YOURSELF How many people live in the home? Adults 1 2 3 4 5 6 7 8 Children 1 2 3 4 5 6 7 8 9 10 Are there any pets kept inside the house? Long Haired Dogs Short HairedDogs Cats Other No Pets
How did you hear about our services or website?
First Name: Last Name: Street Address: City:
State:
ZipCode: Contact Telephone Number: Email Address:
In your opinion what would be a fair price for your cleaning needs:
You will received a response from us within 24 hours
Thank You
