Cleaning Client Information Form

Cleaning Client Information Form
Customer Information
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone
Format: (000) 000-0000.
Email
Preferred Phone
What type of reminder would you like to receive for each service?
About the home

Client's Home Information
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
# of bedrooms
# of bathrooms
Approx. square foot
# of stories
More than 50% carpeted
Additional Services *Cost May Vary*

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