Client Assessment Form

SGHG Cleaning LLC – Client Service

Safety Feedback Form- Revised 9/25/2025
SECTION 1- CLIENT INFORMATION
Business Name
Property Name
Client Contact Name

First NameLast Name
Title/Role
Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Commercial Property Service Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Billing Address (If Different)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Preferred Contact Method

PhoneMailText
SECTION 2- PROPERTY TYPE DETAILS
Cleaning Service Type:

Commercial OfficeCommercial WarehouseIndustrialMult-UnitPost ConstructionOther
Square Footage
Number of Floors/Units
Access Instructions
(Gate codes, security office, key location, etc.)
Parking Availability

YesNo
Restroom to be Served
Breakrooms/ Kitchens
Special Surfaces
(e.g., granite, wood, stainless steel)
SECTION 3- SERVICE REQUESTED

Please evaluate the following places in terms of cleanliness.

	Check All That Apply
General Cleaning
Carpet Cleaning
Window Washing
Trash Removal
Scheduled Janitorial-(strip & wax / buffing)
Post-Construction Cleanup
Deep Clean / One-Time Service
Garage/Out Buildings
Other

Frequency

DailyWeeklyBi-WeeklyMonthlyOne-TimeOther
Service Hours

Business HoursAfter HoursWeekendsOther
Preferred Start Date

MonthDayYear
Date
Contract Term (if recurring)

Month-to Month6 Months12 MonthsCustom
SECTION 4- BILLING TERMS & PAYMENT OPTIONS
Preferred Payment Terms

Net-15Net 30Net 45Net 60 (requires approval)
Billing Frequency

Per VisitWeeklyBi-WeeklyMonthly
Payment Method

ACHCheckCredit/DebitOnline InvoiceFinance Plan
Financing / Extended Terms:
Available on service contracts over $2,500. Must be approved through SGHG Cleaning Credit Department.

Late Payment Fee: 5% of overdue balance per month after due date.
Deposit Requirement: Typically 25–50% for new or one-time services. Waived for established clients with on-time payment history.
SECTION 5- INITIAL CONDITION ASSESSMENT
General Cleanliness Level

LightModerateHeavyDeep
Visible Damage or Safety Hazards
(Note areas of concern, e.g., broken tiles, mold, electrical hazards)
Client-Provided Supplies or Equipment:

TrashbagsCleaning SuppliesCleaning Equipment
Utility Access Confirmed

YesNo
SECTION 6 – CLIENT CONFIRMATION
Client Authorized Person

First NameLast Name
I understand that this quote is based on the initial site assessment and may be subject to change if conditions differ at the time of service. By signing below, I acknowledge that I have read and agree to the SGHG Cleaning LLC Terms of Service, including the Client Reporting Requirement.

“SGHG Cleaning LLC enforces a dry-floor policy to minimize slip hazards. Wet mopping is performed only during after-hours service or with proper signage. By submitting this form, you acknowledge and accept this policy.”
I acknowledge and accept SGHG Cleaning LLC’s dry-floor / wet-mop disclaimer.*

Yes
Date Signed

MonthDayYear
Date
SECTION 7- ESTIMATE SUMMARY (for SGHG Staff Only)
Hourly Rate/Flat Rate
$___________ per hour or $________ flat
Estimated Total (Before Tax):
Estimated Hours
Materials/ Supplies
Travel / Setup Fee (if applicable):
Total Quote
Prepared by SGHG Representative

First NameLast Name
Date

MonthDayYear
Date
SECTION 8- INTERNAL USE ONLY
Quote Number
Follow Up Call Date

MonthDayYear
Date
Status

PendingApprovedConverted to Contract
Digital File Path / QR Entry:
QR_2025_001 or “Scan QR to view full record”
Should be Empty:

SGHG Cleaning LLC – Client Service

SECTION 1- CLIENT INFORMATION

SECTION 2- PROPERTY TYPE DETAILS

SECTION 3- SERVICE REQUESTED

SECTION 4- BILLING TERMS & PAYMENT OPTIONS

SECTION 5- INITIAL CONDITION ASSESSMENT

SECTION 6 – CLIENT CONFIRMATION

SECTION 7- ESTIMATE SUMMARY (for SGHG Staff Only)

SECTION 8- INTERNAL USE ONLY