Initial Intake Form

Client Intake Form
Customer Information
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone
Format: (000) 000-0000.
Email
Please check all preferred days for cleanings (including the day we have you scheduled for)
Please check your preferred times of the day for cleanings
About the home

Client's Home Information
# of bedrooms
# of bathrooms
Approx. square foot
# of stories
Additional Services

Other
Cleaning Supplies:
Special Instructions or Notes:
List tasks to exclude:
Signature
Should be Empty:

Client Intake Form