Pre-Estimate Client Intake

Pre-Estimate Client Intake

Please fill out this form as thoroughly as possible and we will get back to you as soon as we can, thank you!
Name

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
How many bedrooms?
How many bathrooms?
What is the square footage?
How soon would you like to schedule services?
What type of cleaning are you looking for?
How often will you be in need of services?
What date would you prefer to schedule an estimate?

MonthDayYear
Date
What time of day works best for an estimate?

Hour Minutes

AM/PM Option
Any other day/time you would like to include?
Do you have any special cleaning requests or instructions?
Any allergies or sensitivities that the cleaning staff should be aware of?
Do you have any pets? If so, please specify:
Is there a preferred day/time for cleaning? If so, please specify:
Are there any parking or access restrictions for the cleaning staff? If so, please specify:
Are you able to communicate via text message? If not, please specify:
What form of home access will be provided? Please list at least one form of entry to be used:
How did you hear about Newly Maid Cleaning?
Would you like to request that we use only non-toxic products for your home (price may be effected)?
Have you had any professional cleaning in your home previously?
If yes, please briefly expound on your experience and why you are seeking a new service (please include how recent your last professional cleaning was completed):
Are you a former or active military member?
Before your first cleaning can begin, a 50% deposit and a signed service agreement is required. Will either of these steps present any difficulty for you?
If yes, please explain:
What is your preferred form of payment?
Any other important information, special requests, or cleaning add-ons you would like us to know about?
Should be Empty: