Cleaning Client Information Form
Thank you so much for your interest in Chill Mom Cleaning Co. - a residential cleaning service. In order for me to provide you with the most accurate quote and see if we are a fit for eachother, please fill out this form to the best of your knowledge and ability. Once you complete and submit this form I will then: 1-Reach out via email or phone to schedule a walk through of the property. 2-Provide a customized quote that fits your needs. 3-Send over a Service Agreement for you to review and sign. 4-Schedule your first cleaning visit! If you have any questions, please do not hesitate to reach out to me at chillmomcleaningco@gmail.com or give me a call at 929-231-2857.
Customer Information
Name
*
First Name
Last Name
Email
*
By providing your email, you consent to receiving marketing emails and promotions. You can unsubscribe at any time.
Cell Phone Number
*
By providing your phone number, you agree to receive text messages (SMS) from Chill Mom Cleaning Co. You can unsubscribe at anytime by replying STOP. Message and data rates may apply. Message frequency varies.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
What is your preferred method of communication?
*
Text
Email
Phone Call
Does not matter.
What kind of parking is available at the property being serviced?
OFF STREET - Free Parking
ON STREET - Pay to Park
I'll let you know.
How many bedrooms does the property have?
*
How many bathrooms does the property have?
*
What is the square footage of the property?
*
How many floors does your home have? One, two story or three story home?
*
Does this property have pets?
*
Yes
No
Is your property carpeted?
*
Yes, fully.
No, no carpet in sight
Some rooms/halls have carpet.
Are there any special/sensitive surfaces in the property that we should know about?
*
Are there any items/rooms that you would like us to avoid?
*
Have you used a professional cleaning service that cleaned for you regularly in the last 30 days? If so, what were they charging you?
*
What is your budget?
*
What frequency of cleaning services are you looking for?
*
One Time Deep Clean
Listing Photo Preparation
Weekly
Bi-Weekly
Monthly
Move In/Move Out
What day/time do you prefer to have your service done? (Please give time and day options, if possible.)
*
Do you plan on being at the house when we clean it? (The reason we ask is that it is generally easier for us to clean your property as efficiently as possible when no one is in it.)
*
Yes
No
Not sure yet.
Is there anything else you would like to let us know about before we reach out to schedule your walk through appointment? Feel free to share ◡̈
*
How did you hear about us? ◡̈
Walk Through Availability (OPTIONAL) Which day would be best for an assessment of the work? Please include a time.
Walk Through Availability (OPTIONAL) What OTHER day works best for you? Please include a time.
PLEASE SHARE IMAGES OF ALL THE WORK YOU NEED DONE. DON'T LEAVE ANYTHING OUT! (Ex. Dishwashing, laundry, carpet cleaning, bathroom, pet clean up... all of it! ☺️ )
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