Chesapeake Home Assurance Client Inquiry
Your Home Experience Preferences
1. Contact Information
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Preferred Contact Method
Please Select
Phone
Email
How did you hear about us?
Family
Friend
Instagram
Facebook
Other
2. Service Request
Which Package Are You Interested In?
Bay Bridge Breeze (Weekender)
Evening Tide Retreat (Commuter/ Special Occasion)
Not Sure / Need Guidance
Preferred Date(s) of Service
Is this service:
One Time
On-Going / Reoccurring
3. Home Access
Will you be home during the service?
Yes
No
Home Entry Instructions
Are there any animals in the home?
Yes
No
If yes, anything we should know?
Any areas of the home to avoid?
4. Home Preferences
Tell us what your preferences to put you at ease.
Lighting Preferences
Bright & Open
Soft & Ambient
Other
Music Preference?
Yes
No
If yes, any preference? (Classical, Jazz, etc.)
Scent Preference?
Yes
No
If yes, please provide your 3 favorite scents.
What would make your home feel extra special?
Favorite flowers/ colors?
5. Kitchen & Provisioning
Any Dietary Restrictions?
Grocery Shopping Preference
Order Online
Delivery
Personal Shop
Other
Grocery Store Preferred
Safeway
Food Lion
Target
Other
If Other, please list here. (Please note, there will be an additional fee for crossing the Bay Bridge & going beyond Queenstown)
Do you prefer Coffee or Tea?
Coffee (Caffeinated)
Decaf Coffee
Tea
If Tea, please let me know your preference (herbal, green, black, etc.)
Wine Preference
Red
White
N/A
What type of Red or White?
6. Package Add Ons
Are you interested in any of the following add ons?
Driftwood Dreams - Turndown Service
Smooth Sailing - Local Errands
Captains Orders - Vendor Coordination
If any boxes above are checked, please provide any additional details.
Anything Else We Should Know?
If we forgot to mention a preference of yours, please let us know!
Thank you for sharing your home preferences. We’ll review everything and be in touch shortly to confirm your service. We look forward to preparing your home so it feels calm, comfortable, and ready for you.
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