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.
Service Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Type of Cleaning Service*

Standard CleaningDeep CleaningMove-In/Move-Out CleaningCommercial CleaningOther
Pets?*

YESNO
Clutter Level*

LowModerateHigh
General Condition*

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 the Bathrooms have Tile/Grout, Glass Shower, or Fiberglass?*
What type of flooring is throughout the house?*
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.
Should be Empty: