Service Request Form

SERVICE REQUEST FORM
Contact Name*

First NameLast Name or Initial
Company Name (If applicable)
Contact Phone#*
Please enter a valid phone number.
Contact Email*
example@example.com
Property Address*

Street Address

Street Address Line 2

CityProvince

Postal Code
Preferred Access Method*

LockboxDoor CodeCall BoxOn site Meet-upKey Pick-upOther
Is there Parking?*

YesNo
Special instructions (stairs, security, pets, alarms)
Billing Address - Same as Above*

YesNo
If No, provide Billing Address Details below

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
QUESTIONNAIRE
1. What Services are you interested in?*

One-timeWeeklyBiweeklyMonthlyMove In/OutOther
2. Service Start Date Request*

MonthDayYear
Date
Hour MinutesAM/PM Option
3. Type of Service Requested*
Property Type*

OfficeRestaurantRetail ShopCondo/ ApartmentTownhouse / MultiplexDetached Residential HomeProperty Under ConstructionOther
4. Approximate square footage: *
5. Number of Rooms*
6. Are there any special conditions or instructions to note? (damage, stains, biohazards or specific PPE required on-site)
7. Are there any special conditions or instructions to note? (damage, stains, repairs needed)
8. How would you describe dirt level? *

1

2

3

4

5

6

7

8

9

10

1 is not much dirty, 10 is extremely dirty
10. How did you hear about us?*

GoogleFacebookInstagramReferenceLinkedinOther
Photo Upload
File Upload

Cancelof
Note that information collected will remain confidential and be used for quoting & contact purposes only. If you have any questions or concerns or would like to provide any additional details, please contact info@slatecleaningservices.com or visit our website at www.slatecleaningservices.com.
Should be Empty:

SERVICE REQUEST FORM

QUESTIONNAIRE

Photo Upload