Regora Intake Form

Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email Address*
example@example.com
What street is your apartment on?*

Street Address Line 2

City

Postal / Zip Code
Size of Apartment in Square meters
Number of Porches
Number of Bedrooms
Number of Bathrooms
How would you describe the condition of your apartment?*

Relatively CleanDirtyVery DirtyI don't know
Do the beds need to be prepared?*

YesNoNot applicable (No beddings needed)
If yes, is the linen ready for use in the apartment or does it need to be washed and dried as well?*

Ready for useNeed to be washed and driedNot applicable (no linens needed)
When will your apartment be empty and available to be cleaned? The apartment will be empty on :*

MonthDayYear
Date
Time*

Hour Minutes

AM/PM Option
Guests arrive at: *

MonthDayYear
Time*

Hour Minutes

AM/PM Option
Requested Cleaning Package:*

Surface Clean PackageDeep Clean PackageFull Management PackageNot sure yet
Do you have a discount code?
Message/ Other Inquiries:
How do you prefer to receive your quote?

EmailWhatsappPhone callText
Please verify that you are human*
Should be Empty: