New Client Intake
"Bringing order & freshness to your home, one project at a time."
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell Phone
Format: (000) 000-0000.
E-mail
example@example.com
Square footage of home
# of bedrooms in home
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
# of bathrooms in home
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
In the event we have to reach while your cleaning appointment is taking place what is your preferred means of contact?
Please Select
Call
Text
What type of service applies to you?
One Time Appointment
Weekly Service
Bi-weekly Service
Monthly Service
Eviction
Organizing & Storage Solutions
Move In/Out
Care Crew
Date Requested for first service
-
Month
-
Day
Year
Date
Do you have any preferred days and times for cleaning?
How do we gain entrance?
Keys/keypad
Someone will grant access
Other
Do you have any pets in the home? If so, how many?
Do you smoke in the home?
Yes
No
What types of flooring do you have?
Does anyone have any allergies to products or scents?
Will anyone be home while we are cleaning?
Is there any surfaces or items that need special care?
Preferences; anything you want us to focus on? or anything to avoid?
In the last 6 months have you had another housekeeper? If so, what was the reason for discontinuing their services?
What's the reason you're hiring a cleaner?
How did you hear about us?
Is there anything else we need to know about you or you home?
Submit Form
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