Cleaning Service Request Form
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
How did you hear about us?
Referral
Web Search
Social Media
Property Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Estimated Total Square Footage
Type of Residence
Please Select
Apartment
Commercial
Residential
Duplex/Triplex
Condo
Office
Other
Type(s) of Flooring
Tile
Carpet
Hardwood
Vinyl
Marble
Other
#of Bedrooms
Please Select
1
2
3
4
5
6
7
8
9
10
#of Bathrooms
Please Select
1
2
3
4
5
6
7
8
9
10
Additional Services (Additional fee)
Iron
Windows
Walls
Furniture
Garage
Deep Cleaning Carpets
Oven Cleaning
Payment Method
Please Select
Cash
Check
Credit Card
Below sections will be filled out by the Company.
Quote
Price ($)
Hours per week
Total Cost ($)
Floors
Windows
Walls
Furniture
Garage
Carpets
Total Amount ($)
Quote Prepared by
First Name
Last Name
Signature
Continue
Continue
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