Dusty Bits Cleaning Service
New Client Contact Form:
Full Name
*
First Name
Last Name
Address of Cleaning Site
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is this a home or business?
Please Select
Home
Business
E-mail
*
example@example.com
Phone Number
(Questions or emergencies on day of service will use this number)
How do you prefer to be contacted?
*
Please Select
Phone
Email
*Emergency contact will be made via phone
Are you looking for Occasional or Weekly help?
Please Select
Occasional
Weekly
Weekends or Weekdays?
Please Select
Weekends (sat/sun)
Weekdays (M-F)
Either/no preference
Which service do you expect to use us the most for?
Please Select
2 hour sessions (most popular for weekly frequency)
4 hour sessions (most popular for occasional frequency)
8 hour sessions
Other
Will you be home during cleaning hours?
Please Select
Yes, I plan to always be present
No, I plan to be away during cleaning hours
Mix of both, Don’t know yet
Do you have pets that will be in the home during cleaning hours? If so please describe them, their temperament, and anything we should know.
Please give us more details about your cleaning needs:
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Should be Empty: