Client Intake Form

Client Intake Form

Client Intake Form

Getting to know you
Name*

First NameLast Name
Spouse/Roomate Name

First NameLast Name
Main Contact number*
Please enter a valid phone number.Format: (000) 000-0000.
2nd Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
PROPERTY

How can we be of service?
Property Address *

Street Address

Street Address Line 2

CityState

Zip Code
Square footage of home
How many bedrooms & bathrooms?
ALLOTTED TIME ALLOWED (if paying per hour)

Hour Minutes

AM/PM Option
Property access (Key/Door code/Keyless entry, Alarm Code)
Do you have Animals? What Type? How many?
PREFERABLE DAYS & TIME (after 10:30am)
ROOMS TO AVOID
Prioritize services if paying hourly
Location of Central Trash Container

CHOOSE ALL SERVICES WANTED FOR EACH AREA NEEDING TO BE CLEANED

Rows	DUST	DRY DUST BLINDS/WINDOW SILLS	DUST CEILING FAN	DISINFECT SURFACES	VACUUM/MOP FLOORS
FAMILY ROOM
DINING ROOM
KITCHEN
MASTER BEDROOM
MASTER BATHROOM
BEDROOM #1
BEDROOM #2
BEDROOM #3
BEDROOM #4
BATHROOM #1
BATHROOM #2
BATHROOM #3 OR MORE
OFFICE
LAUNDRY ROOM
HALLS/ENTRYWAY/STAIRS

Anything that you would like to add?
EXTRAS
Sort By

Name: A to Z

Name: Z to A

Price: Low to High

Price: High to Low

Clear Sort
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Linen Change – Clean Linens Must be Left on Bed
Enter description

$10.00



Linen and Duvet Cover Change – Clean Linens Must be Left on Bed
$15.00



Dishwasher Load or Unload
per load

$10.00



Oven Cleaning Inside

$25.00



Refrigerator Inside
$35.00



Refrigerator and Freezer Inside
$45.00



Damp Wipe all Woodwork, Doors, Trim, Moldings, Baseboards
$50.00



Total

$0.00
Terms and Conditions*
Should be Empty: