Home Cleaning Service Agreement
We hope that you enjoy our service and we encourage you to provide us with any feedback.
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Format: (000) 000-0000.
Emergency Contact
Format: (000) 000-0000.
E-mail
example@example.com
Square footage of home
# of bedrooms in home
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
# of bathrooms in home
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Do you have pets?
Please Select
Yes (dog)
Yes (cat)
No
Do you have kids
Please Select
Yes
No
When was the last time you had a cleaning service at your home?
What type of service applies to you?
First Time Appointment
One Time Appointment
Weekly Service
Bi-weekly Service
Monthly Service
How do we gain entrance?
Keys with office
Keys with doorman
Someone will grant access
Other
SPECIAL INSTRUCTIONS
Signature
Submit Form
Submit Form
Should be Empty: