EcoBee Home Cleaning - Intake Questionnaire

1
Provide your name* This field is required.
Mr.
Mr.
Ms.
Mrs.
Dr.
Prefix
First Name
Last Name
Suffix
2
Provide your primary e-mail* This field is required.We use end-to-end encryption and never sell client data
example@example.com
Email Verified
The verification code has been sent to some@email.com
Please check your mailbox and paste the code below to complete verification
••••
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3
What size is your home?* This field is required.Enter the square footage number that best describes your home
4
How many bedrooms?* This field is required.Enter the number of bedrooms in your home
5
How many bathrooms with a tub/shower?* This field is required.Enter the number of bathrooms with a tub or shower
6
How many bathrooms without a tub/shower?* This field is required.Enter the number of half baths
7
How much of your home is has carpet flooring?* This field is required.Select a percent estimate for your home's carpeted area
0 - 25%
25% - 50%
50% - 75%
75% - 100%
8
Select any/all specialty cleaning services you may want to includeSelect all that apply
Pet hair removal (dog/cat)
Refrigerator cleaning
Window cleaning
Jetted tub cleansing flush
Oven deep cleaning
Carpet cleaning
9
Please verify that you are human* This field is required.
10
Calculation - DEEP CLEAN
11
Calculation - CLASSIC CLEAN
12
Calculation - Gold Membership
13
Calculation - Platinum Membership
14
Calculation - Diamond Membership
15
Select Your Plan* This field is required.Save up to 25% OFF with a Monthly Plan
prevnext( X )
GOLD Membership
Schedule up to 2 house cleanings per month
USD for each month
SIGN ME UP
PLATINUM Membership
Schedule up to 3 house cleanings per month
USD for each month
SIGN ME UP
DIAMOND Membership
Schedule up to 4 house cleanings per month
USD for each month
SIGN ME UP
Deep Clean
Single deep clean, required for all first-time home cleanings
USD one-time payment.
SIGN ME UP
Classic Clean
Single classic clean, available to existing clients ONLY
USD one-time payment.
SIGN ME UP
Enter Coupon
Credit Card
First Name
Last Name
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