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Name
First Name
Last Name
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Service Requested
Covid-19 Disinfecting
Office Cleaning
Carpet Cleaning
Floor Waxing
Window Cleaning
Location Type
Medical / Healthcare
Commercial (Office/Building)
Medical / Healthcare
Residential (Apartments)
House
Frequency
1x
3x (M-W-F)
5x (M - F)
7x Weekly
Quarterly (windows)
Approximate Size
500sf - 1000sf (avg. 1br)
1000sf - 2000sf (2br - 3br)
2000sf - 3000sf (3br - 4br)
3000sf - 4000sf
4000sf - 5000sf
5000sf +
# of Restrooms
1
1.5
2
2.5
3
3.5
4
4.5
5 +
Date service is needed?
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