Cleaning Request Form (Website Form)
Type of Service
*
NDIS Cleaning Service
Cleaning Service
Client or NDIS Representatives Details
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
NDIS Client or Client Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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NDIS Participant Details
Please skip this section if you are not an NDIS participant.
NDIS Participant Number
NDIS Funding Management Type?
Self-Managed
Plan-Managed
Birth Date
-
Day
-
Month
Year
Date
To make sure the service is appropriate and safe, are there any support needs or risks we should be aware of during the clean? For example: Chemical sensitivities or allergies to foods.
Important:
Unfortunately, we do not accept NDIA-managed Clients. We are very sorry for the inconvenience.
Plan Manager Details
Manager Name
First Name
Last Name
Plan Managers Invoicing Email
example@example.com
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Property Details
Number of levels?
Please Select
1
2
3
4
Number of Bedrooms?
Please Select
1
2
3
4
5
6
7
Number of Bathrooms?
Please Select
1
2
3
4
5
6
7
Number of Living Areas?
Please Select
1
2
3
4
Number of Seperate Toilets?
Please Select
1
2
3
4
Do you have a laundry?
Please Select
Yes
No
Pets?
Please Select
Yes
No
Last Professional Clean?
Please Select
Week
Fortnight
Month
3 Months
Never
Parking Availability?
Please Select
My driveway
Free Street Parking
Paid Street Parking
Paid Carpark
Property Access
Please Select
Hidden Key
Lockbox
Door Code
Someone Will Be Home
Set Of Keys
Garage Remote
Other
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Additional Services
Additional services will add additional time to the invoice. Additional services cannot be added on the first clean but are available in your second clean. We will note your add-ons for future reference.
Please Select if needed:
Inside Sliding Door Glass (10mins)
Clean Inside Empty Fridge (1 Hour)
Change Bed Linen for 1 Bed (10mins)
Change Bed Linen for 2 Beds (20mins)
Change Bed Linen for 3 Beds (30mins)
Change Bed Linen for 4 Beds (40mins)
Change Bed Linen for 5 Beds (50mins)
Dishwasher Interior Clean (30mins)
Venetian Blinds (Whole House) (1.5 Hours)
Microwave Interior Clean (20mins)
Ceiling Fans 4-7 (>3m) (30mins)
Kitchen Cupboards Exteriors (30mins)
Rangehood & Filter Degrease and Clean (30mins)
AirFryer or Slow Cooker Clean (30mins)
Wash 1 Sink of Dishes (20mins)
Wash 2 Sinks of Dishes (40mins)
Rubbish Removal (15mins)
Tidying 30mins
Tidying 1 Hour
Tidying 2 Hours
Shower Fan Cover Clean (10mins)
Deep Clean Kitchen (30mins)
Deep Clean Kitchenette
Deep Clean Bathroom (30mins)
Deep Clean 2 Bathrooms (1 Hours)
Deep Clean 3 Bathrooms (1.5 Hours)
Deep Clean 4 Bathrooms (2 Hours)
Deep Clean 5 Bathrooms (2.5 Hours)
De-Cob Web Home Interior (30mins)
Oven Clean (1.5 Hours)
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Cleaning Service Details
Please choose a prefered date and time unless you have already booked, you will recieve this section prefilled.
Appointment
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Terms & Conditions
Please kindly read the terms and conditions.
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