New Customer Registration Form
Customer Details:
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Format: (000) 000-0000.
E-mail
example@example.com
Date
-
Month
-
Day
Year
Date
How long has it been since you've had a Deep clean? Completed by another company/individual
1-2 weeks
3-4 weeks
1 month-3months
4 months or more
Services requested
Please Select
Basic cleaning
Deep cleaning
After event clean up
Disinfecting and sanitizing
Frequency you are needing services
Please Select
One time
Weekly
Bi-weekly
Monthly
#of Bedrooms and # Bathrooms (ex. 2bed 2 1/2 bath. 1/2 bath do not include shower/bathtub)
Please list all types of flooring. (Ex. Carpet, tile, vinyl)
Requested appointment (please note this is not a confirmed appointment time, but we will do our best to accommodate your desired appointment date and time!)
Accommodations needed
Allergies to cleaners
All natural products
Asthma
Is there anything else we should know?
Please upload at least one clear photo of each room. (For online quotes only. If you desire a in person walk through quote you can skip this step)
Browse Files
Drag and drop files here
Choose a file
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How did you hear about us?
Family/friend (word of mouth)
Facebook
Nextdoor
LinkedIn
Other
Signature
*
Please verify that you are human
*
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