Cleaning Client Intake Form

Cleaning Client Intake Form

Please provide your details and cleaning preferences to request service.
Full Name*

First NameLast Name
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Service Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone CallTextEmail
Standard CleaningBiweekly or Weekly Maintenance CleaningDeep CleaningMove-In/Move-Out CleaningCommercial CleaningOther
YESNO
LowModerateHigh
MaintainableNeeds Extra EffortDeep Clean Required
Preferred Date and Time for Cleaning

MonthDayYear
Date
Hour MinutesAM/PM Option
Number of Bedrooms*
Number of Bathrooms*
Sqft of Building*
Do your Bathrooms have Tile/Grout, Glass Shower Door, or Fiberglass?
Be specific, which one, and in which bathrooms.
What type of flooring is throughout the house?
Carpet, hardwood, laminate, vinyl, tile, etc.
Do you have any chemical or fragrance sensitivity?
Be specific if you have certain needs.
Any special instructions or requests?
If you'd like any add-on services you can input here.
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