Cleaning Service Agreement Form

LW Client Cleaning Service Agreement

Thank you for choosing Us to provide your residential/commercial cleaning needs. Please fill out the form below and a Loyal Winston Representative will contact you to confirm your appointment.
Name*

First NameLast Name
Desired Appointment Date? *

MonthDayYear
Alternative Date? *

MonthDayYear
*Second option if original date isn’t available.
Service Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Contact Number*

Area CodePhone Number
E-mail*
Booked on MP WebsiteGrouponBooksyLiving SocialOther
Please provide your Gift Card or Voucher Code information to confirm your purchase. *
*Redemption Code will NOT be redeemed until the day of scheduled appointment.
Square footage of home
# of bedrooms in home to be cleaned*
# of bathrooms in home to be cleaned*
In the event we have to reach you while your cleaning appointment is taking place what is your preferred means of contact?*
First Time AppointmentOne Time AppointmentWeekly ServiceBi-weekly ServiceMonthly Service
Keys with officeKeys with doormanSomeone will grant access
Apartment (Standard)Apartment (Deep)House (Standard)House (Deep)Small OfficeDeep Clean of AppliancesCarpet CleaningOffice Cleaning (Medium)Office Cleaning (Large)Window CleaningGym Facility Cleaning
If this is a Deep Clean, please select the large kitchen appliance that you wold like to have serviced?*
Does your home have hardwood floors or carpet?*
If you have carpet, do you prefer to use your personal vacuum?*
Please provide a brief description of the areas you would like for us to pay special attention to (ex. Underneath beds & couches vs kitchen stovetop or window sills):
Please type your full name. This will serve as your electronic signature.*
Please email mePlease call meDon't email/call, I am OK with any replacements
Should be Empty:

LW Client Cleaning Service Agreement