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
Tell us more about your home: What is the approximate square footage of your home? 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? 0 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
In what Area of town or city are you located? 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 a professional cleaning service? How did you hear about our services or website?
First Name: Last Name: Street Address: City:
State:
ZipCode: Contact Telephone Number: Email Address:
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