Client Cleaning Service Request

Cleaning Service Request Form

Thanks for contacting Luminaclean Facilities Services LTD. How may we help?
Customer Information
Name

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone

Area CodePhone Number
Email*
What type of cleaning service are you looking for?*
Is this a one-time service or regular/ongoing?*
Pick a date for our pre-clean assessment visit.

MonthDayYear
Date
Pick a time for our pre-clean assessment visit.

Hour Minutes

AM/PM Option
Type of property*
About the property

Client's property Information
# of bedrooms*
# of bathrooms*
# of Kitchen/dinner*
Approx. square foot
# of offices/work spaces*
Do you have any Pets?
Additional Services

Carpet CleaningWindow CleaningUpholstery CleaningLaundry ServiceDishwashingDeclutter & OrganizeOther
Cleaning Supplies:

Client will provide cleaning supplies.Cleaning company to provide cleaning supplies.
Special Instructions or Notes:
List tasks to exclude:
Signature

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