Customer Contact Information
Name
*
First Name
Last Name
Cell Phone Number
*
Format: (000) 000-0000.
Email
*
example@example.com
Are you a new or returning customer?
*
New Customer
Returning Customer
Not Sure
Service Address
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is this a residential or commercial property?
*
Residential
Commercial
HOA / Multi-unit / Property management
Main Service Details
What service are you requesting?
Trash Bin Cleaning
Exterior House Wash / Soft wash
Concrete Cleaning
Window Cleaning
Roof Wash
Gutter Cleaning
Deck / Fence Cleaning
Commercial Pressure / Soft Washing
Fleet Washing
Other
Trash Bin Cleaning Section
Which Trash Bin Cleaning Service would you prefer? ***Each service includes cleaning/sanitizing/deodorizing ***
Monthly Subscription ($25 Monthly, 1 Bin, 1 cleaning every 4 weeks, 12-monthcommitment)
Seasonal Subscription ($30 Monthly, 1 Bin, 1 cleaning every 4 weeks, *April-November*, 1 season commitment)
Bi-Monthly Subscription ($35 Bi-Monthly, 1 Bin, 1 cleaning every 8 weeks, 12-month commitment)
Quarterly Subscription ($45 Quarterly, 1 Bin, 1 cleaning every 12 weeks, 4 quarter commitment)
One-Time ($63 One-Time, 1 Bin)
Not Applicable
What date would you like to have your trash bin/s cleaned? (Date should be the same day of the week as your trash pickup)
-
Month
-
Day
Year
Date
Add additional bins to your cleaning, how many additional bins would you like to add? ($10 for each extra bin)
What day does your trash get picked up?
Monday
Tuesday
Wednesday
Thursday
Friday
What time does your trash get emptied? (Select latest time it gets emptied on a normal week)
Hour Minutes
AM
PM
AM/PM Option
How often is your recycling picked up? (If applicable)
Weekly
Bi-Weekly
Monthly
What date is your next recycling pickup? (If applicable)
-
Month
-
Day
Year
Date
Exterior House Wash / Soft Wash Section
How many stories is the home/business
1 Story
2 Stories
3 Stories
Not Sure
Approximate Home Size
Under 1,500 sq. ft.
1,500-2,500 sq. ft.
2,500-3,500 sq. ft
3,500+ sq. ft.
Not Sure
What type of siding?
Vinyl
Brick
Aluminum
Wood
Stucco
Mixed Materials
Not Sure
Is water available on-site?
Yes
No
Not Sure
Upload photos (Not required)
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Concrete Cleaning Section
What concrete areas need cleaned?
Driveway
Sidewalk
Front Walkway
Patio
Pool Deck
Garage Floor
Commercial Concrete
Other
Approximate size of the area?
Small
Medium
Large
Not Sure
What type of staining is present?
Dirt / Grime
Green Algae
Oil Stains
Rust Stains
Tire Marks
Paint
Other
Is water available on-site?
Yes
No
Not Sure
Upload photos (Not required)
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Window Cleaning Section
What type of window cleaning do you need?
Exterior Only
Interior Only
Interior and Exterior
Not Sure
Approximate number of windows?
1-10
11-20
21-30
31-40
40+
Not Sure
What type of window cleaning do you need?
Exterior Only
Interior Only
Interior and Exterior
Not Sure
How many stories is the home/business?
1 Story
2 Stories
3 Stories
Not Sure
Do you want screens cleaned?
Yes
No
Not Sure
Do you want tracks/sills cleaned?
Yes
No
Not Sure
Is water available on-site?
Yes
No
Not Sure
Upload photos (Not required)
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Roof Wash Section
What type of roof do you have?
Asphalt Shingles
Metal
Tile
Other
Not Sure
What issue are you seeing?
Black Streaks
Moss
Algae
General Dirt
Not Sure
Approximate roof age?
0-5 Years
6-10 Years
11-20 Years
20+ Years
Not Sure
How many stories is the home/business?
1 Story
2 Stories
3 Stories
Not Sure
Is water available on-site?
Yes
No
Not Sure
Upload photos (Not required)
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Gutter Cleaning Section
How many stories is the home/business?
1 Story
2 Stories
3 Stories
Not Sure
What issue are you having?
Gutters are full
Water overflowing
Downspouts clogged
Plants growing in gutters
Not Sure
Approximate last time gutters were cleaned?
Within 6 Months
Within 1 Year
Over 1 Year
Never / Not Sure
Are gutter guards installed?
Yes
No
Not Sure
Is water available on-site?
Yes
No
Not Sure
Do you want the debris bagged or not?
Bagged
Not bagged
Not Sure
Upload photos (Not required)
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Deck / Fence Cleaning Section
What needs cleaned?
Deck
Fence
Dock
Other
Material type?
Wood
Composite
Vinyl
Treated lumber
Not Sure
Approximate size of the area?
Small
Medium
Large
Not Sure
What issues are present?
Green algae
Dirt / grime
Mold / mildew
Old stain / sealer
Other
Is the surface painted, stained, or sealed?
Painted
Stained
Sealed
Bare wood
Not Sure
Is water available on-site?
Yes
No
Not Sure
Upload photos (Not required)
Browse Files
Drag and drop files here
Choose a file
Cancel
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Commercial Pressure / Soft Washing Section
Company Name
Your Role / Position
Type of Property
Storefront
Restaurant
Office Building
Apartment Complex
HOA
Industrial
Property Management
Other
What areas need cleaned
Building exterior
Sidewalks
Dumpster pad
Drive-thru
Parking lot areas
Equipment
Fleet
Other
Is this a one-time service or recurring service?
One-time
Weekly
Monthly
Quarterly
Seasonal
Not Sure
Preferred Service Time
During business hours
After hours
Weekend
Flexible
Is water available on-site?
Yes
No
Not Sure
Is there a property manager or site contact?
Yes
No
Site Contact Name
Site Contact Number
Please enter a valid phone number.
Format: (000) 000-0000.
Upload photos (Not required)
Browse Files
Drag and drop files here
Choose a file
Cancel
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Fleet Washing Section
Company Name
How many vehicles need washed?
Vehicle Types
Pickup trucks
Box trucks
Semi Trucks
Trailers
Vans
Heavy equipment
Other
Desired Frequency
One-time
Weekly
Bi-weekly
Monthly
Quarterly
Not Sure
Preferred Service Time
During business hours
After hours
Weekend
Flexible
Is water available on-site?
Yes
No
Not Sure
Upload photos (Not required)
Browse Files
Drag and drop files here
Choose a file
Cancel
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Assessment / Quote Scheduling
Would you like to schedule an assessment? (Trash bin cleaning does not require assessment)
Yes
No, quote from photos & Google Earth
Not Sure
Which day would be best for an assessment of the work? (Trash bin cleaning does not require assessment)
-
Month
-
Day
Year
Date
What are your preferred arrival times?
Anytime
Morning
Afternoon
Evening
Referral / Marketing Information
Where did you find us?
*
Google
Facebook
Referral
Yard Sign
Door Hanger
Existing Customer
Realtor
HOA
Other
Referral Name, if applicable.
Discount/Association Rebate Code:
Consent / Final Confirmation
*
I understand G.I. Bins may contact me by call, text, or email regarding this request.
Submit Request
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