Cleaning Request Form
Hello & welcome to Simply Clean Services' cleaning request form! Please complete this form in full to ensure an accurate quote and proper service scheduling.
Client Contact Info
Email
*
example@example.com
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Property Address (with unit # if applicable)
*
Street Address
Street Address Line 2
City/Town
State / Region
Postal / Zip Code
Service Type Requested
*
Please Select
Standard Clean
Custom Clean
Deep Clean
Move-in/ Move-Out Clean
Post Construction
Air BNB
Home Details
Type of Residence
*
Please Select
Apartment
House
Duplex/Triplex
Condo
Office
Other
How Many Levels
*
Please Select
1
2
3
Total Square Footage (Approx)
#of Bedrooms
*
Please Select
1
2
3
4
5
6
7
8
9
10
#of Full Bathrooms
*
Please Select
1
2
3
4
5
6
7
8
9
10
# of Half Bathrooms
*
Please Select
1
2
3
4
5
Pets in the home?
*
Please Select
Yes
No
Type & # of pets
Cleaning Condition Assessment
Select the option that best describes the current condition of your home. Honest selections help ensure accurate pricing and scheduling.
*
Light- Recently cleaned, minimal buildup, light dust
Moderate- Noticeable dust, soap scum, grease, water spots
Heavy- Thick buildup, heavy grease, hard water stains, neglected areas
Type(s) of Flooring throughout house
*
Tile
Carpet
Hardwood
LVP Flooring
Vinyl
Marble
Other
Booking Date
*
-
Month
-
Day
Year
Date
Booking Time
Please Select
9-930Am
10-10:30Am
11-11:30Am
12-12:30Pm
1-1:30Pm
Are you flexible on the date and time?
Please Select
Yes, I am
No, I’m not
Anything else you would like us to know? (Do you prefer certain supplies, are you allergic to any cleaning supplies)?
Frequency
*
Please Select
One Time
Weekly
Bi-Weekly
Monthly
Your Contact Prefrence? For faster response, please select text option.
Please Select
Phone (Call)
Phone (Text)
Email
File Upload
Browse Files
Drag and drop files here
Choose a file
Please upload clear photos of kitchen, bathrooms, main living floors, and areas of concern. For custom cleans, please just upload requested rooms!
Cancel
of
Agreement
*
Pricing is based on size, service type, and condition of the home. I Understand that this is a request only and will be confirmed by "Simply Clean Services".
Submit
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