Cleaning Service Request Form Template
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
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
Services Requested
One time regular clean
One time deep clean
Move in/Move out clean
Recurring cleaning (weekly, biweekly, monthly)
Laundry (max load: 1 wash/dry/fold
Inside oven
Inside fridge
Hand wash dishes
Inside cabinets
Inside trash can
Wall washing
Organization
Office cleaning
Payment Method
Please Select
Cash
Cash app
Below sections will be filled out by the Company.
Quote
Price ($)
Hours per week
Total Cost ($)
OTRC
OTDC
MI/MO
Recurring
Add ons
Total Amount ($)
Quote Prepared by
First Name
Last Name
Signature
Submit
Submit
#of Bathrooms
Please Select
1
2
3
4
5
6
7
8
9
10
Should be Empty: