Cleaning Service Request Form for Nook & Cranny Cleaning LLC
(Please fill out all areas for an accurate estimate.)
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Preferred form of contact:
*
Please Select
Text
Call
Email
Service Details:
Type of Service Requested
*
Reoccurring Residential Cleaning
Deep Residential Cleaning
Move-In Residential Cleaning
Move-Out Residential Cleaning
Nesting Cleaning (to prepare home for baby’s arrival)
Postpartum Maternity Cleaning (to help new mom after delivery)
Post-Construction (residential)
Office Cleaning
Short-term Rental/Airbnb/VRBO
Organization/Decluttering (residential)
Other (please explain)
Other
Move-in/Move-out: Is the residence empty of all furniture and/or personal belongings? (If move-in/move-out cleaning is needed, the residence will need to be empty; no furniture and/or personal belongings).
Yes
No
Frequency
*
One-Time
Bi-Weekly
Monthly
Preferred Date and Time
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Property Details:
Additional Services Requested (additional charges apply):
Inside Oven Cleaning ($50 add. charge)
Inside Refrigerator Cleaning ($40 add. charge)
Inside Freezer Cleaning ($40 add. charge)
Interior Window Cleaning ($8/ per window add. charge)
Vinyl Blinds ($5/ per set of blinds add. charge)
Lanai ($50 add. charge)
Baseboards ($60 add. charge)
Inside dryer vent trap & filter area ($20 add. charge)
Inside cabinets ($40 add. charge)
Other (additional charges apply)
Type of Property
*
House
Apartment
Condo
Office
Other (Please Specify)
Total number of pets & type of pets
*
Number of Bathrooms
*
Number of Bedrooms
*
Square Footage (per tax card information)
*
Please provide clear, well-lit photographs of all areas that will be serviced. This helps with the estimate process and serves as a “virtual walkthrough”.
Have you ever had a professional cleaner service your property?
*
Please Select
Yes
No
Are there any human or pet biohazard materials present (urine, blood, feces, etc)?
*
Please Select
Yes
No
Are there any active infestations (roaches, bed bugs, ants, rats, mice, etc)?
*
Please Select
Yes (if yes, please explain)
No
If the answer is yes to the question above, please specify what type of infestation:
How did you hear about us?
*
We offer a 20% discount for all active duty military, veterans, law enforcement and senior citizens. (Verification required to receive these discounts. This discount cannot be combined with other discounts.)
Active Duty Military
Veteran
Law Enforcement
Senior Citizen
I am not active duty military, I am not a veteran, I am not involved in law enforcement and I am not 65+
Discount Code/ Referral Code (if applicable)
Signature
*
Date
*
-
Month
-
Day
Year
Date
Continue
Continue
Should be Empty: