Personal information
All personal information is kept 100% private. Your information will never be sold or revealed to third parties. This information is strictly for my customer database used to better service my clients.
Name
*
Prefix
First Name
Last Name
Suffix
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Details
How long have you lived in your home?
*
How many bathrooms?
*
How many bedrooms?
*
Approximately what is the sq footage of your home?
*
Do you know what year your home was built?
*
What types of flooring do you have in each room.(hardwood, marble, laminate, carpet), and do you have specific preferences for how they are treated?
*
Are there any surfaces that require specialized care (e.g., unsealed stone, antique wood, or stainless steel)?
*
Job details
Have you had a housekeeper within the last 3 months?
*
Yes
No
If yes Do you know when you're last deep clean was?(This usually entails baseboards being scrubbed, door frames scrubbed, ECT)
*
Are there any pets in home? If yes please list all there species, breed and age if applicable .
*
Will you be requiring any pet services if so? (Waist cleanup or removal, medication administration, walks ect)
*
Are there any outside areas that will need to be cleaned?
*
Do you prefer conventional cleaners, or do you have a preference for plant-based, eco-friendly, or scent-free solutions?
*
Please check all services you will be requiring
*
Standard clean
Deep Clean
One Time Only
Reoccurring
Dishs
Pet services
Laundry
Carpet Shampooing
Linens
Eco Friendly Supplies
Move out /In Cleaning
Post-Constructuon Cleanup
Sanitation
Steam Cleaning
Organization
Automobile detailing/washing
Undecided
Other
Are there any add-ons you would like done?
*
Dishs
Laundry
Walls
Fireplace
Animal waist removal
Carpet/ Rug Cleaning
Steam Cleaning/ Sanitation
Appliance Referbish
Furniture
Windows
Pressure washing
Pool/ hot tub/Jacuzzi
Pet Services
None
Other
People In Your Home
How many adults over the age of 18 live in home?
*
What are the occupations of all persons working in your home?
*
How many children under the age of 18 live in home, ?
*
Of those children how many are under the age of 10?
*
Does anyone in the household have sensitivities or allergies to specific scents or chemicals? If yes Please explain
*
Legal
Will you be requiring references, backround check or insurance information?
Would you be willing to sign a Non-Disclosure Agreement?
*
Would you be willing to sign a Liability Waiver?
*
Do we have you permission to photo/ video you home for means of before and after media while keeping your privacy? Note this content may get posted online. Pictures of you or your household members or your personal information will never be posted.
*
Discount Questionnaire
If you think you may qualify for any of our available discount programs please fill out this questionnaire and download a copy for your records. These questions are not required, you may skip if not interested in eligibility
How did you hear about Meyers Green Clean
If referred by a client please provide there first and last name as well as the address serviced in order for you both to receive your referral discount.
Are you currently disabled or are you currently the caretaker of any sort of disabled persons? If yes please explain.
Are you or any family member now or have ever been in the military, a police officer, a firefighter , an EMT, an education professional, in the medical field, train or care for service animals or a community service volunteer?If yes, please explain.
Are you or anyone under your care over the age of 60?
Does anyone in your home receive Food Stamps or participate in any other State Assistance Programs? If yes please explain.
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