OBSIDIAN CLEAN CO. MOVEIN / MOVEOUT CLIENT INTAKE FORM
Share your property details and cleaning needs so we can prepare an accurate quote—booking is only confirmed once Obsidian Clean Co. accepts and schedules your service.
Client & Contact Information
Full Name
*
First Name
Middle Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Preferred Contact Method
Please Select
Phone
Text Message
Email
Other
Service Request Details
Service Type
*
Move-In Clean
Move-Out Clean
Pre-Listing Clean
Post-Renovation/Construction Dust Reset
Other
Preferred Service Date and Time
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Urgency
*
Please Select
Standard
Urgent
ASAP
Flexible
Required Completion Date or Deadline
*
Property Information
Property Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Access Instructions
*
Home Type
*
Please Select
Single-family home
Condominium
Townhouse
Apartment
Duplex
Multi-family home
Other
Approximate Square Footage
*
Number of Bedrooms
*
Number of Bathrooms
*
Number of Levels
*
Basement
Please Select
No basement
Unfinished basement
Finished basement
Partial basement
Unknown
Occupancy Status
*
Please Select
Occupied
Vacant
Partially occupied
Unknown
Utilities On
Water
Power
Heat
Lighting
What style of baseboards does your home have?
*
Smooth, flat rectangular boards
Rounded, sloped, or decorative profiles
Not sure
What types of flooring are in the home?
*
Hardwood
Laminate
Vinyl
Tile
Carpet
Natural stone
Other
Condition & Scope Assessment
Overall condition of the property
*
Excellent
Good
Fair
Poor
Unsure
Condition concerns present
Dust/Construction Debris
Pet Hair
Smoke/Odours
Heavy Grease
Hard Water Stains
Mould Concerns
Pests
Garbage/Items Left Behind
Recent Renovations
Other
Is the property currently vacant?
*
Yes
No
Partially
Rooms and areas to clean
*
Kitchen
Bathrooms
Bedrooms
Living Areas
Entryways
Closets
Laundry Room
Basement
Garage
Interior Cupboards/Drawers
Appliance interior add-ons
Fridge
Freezer
Oven
Dishwasher
Microwave
Washer/Dryer Area
Additional service requests
Wall Washing
Baseboards
Interior Windows
Window Tracks
Blinds
Light Fixtures
Vents
Inside Closets/Cabinets
Dust or construction debris level
None
Light
Moderate
Heavy
Pet hair presence
None
Light
Moderate
Heavy
Heavy grease buildup
No
Slight
Moderate
Heavy
Hard water staining
No
Slight
Moderate
Heavy
Recent renovations completed
No
Yes, minor
Yes, major
In progress
Kitchen areas to assess
Countertops
Sink
Cabinets
Backsplash
Flooring
Appliances
Pantry
Bathroom areas to assess
Sink
Toilet
Tub/Shower
Tile/Grout
Mirror
Cabinetry
Flooring
Bedroom areas to assess
Floors
Closets
Baseboards
Windows
Window Tracks
Blinds
Light Fixtures
Living area spaces to assess
Floors
Baseboards
Windows
Window Tracks
Blinds
Light Fixtures
Vents
Entryway areas to assess
Floors
Walls
Doors
Baseboards
Windows
Window Tracks
Light Fixtures
Closet areas to assess
Shelves
Rods
Floors
Baseboards
Doors
Inside Closets
Cabinet Interiors
Laundry room areas to assess
Floors
Sink
Cabinets
Appliance Surroundings
Vents
Baseboards
Walls
Basement areas to assess
Floors
Walls
Stairs
Storage Areas
Windows
Vents
Baseboards
Garage areas to assess
Floors
Shelving
Corners
Doors
Windows
Baseboards
Wall Surfaces
Interior cupboards and drawers
Kitchen Cupboards
Bathroom Cupboards
Bedroom Drawers
Hall Storage
Other Storage
Interior cupboards and drawers condition
Empty
Partially Filled
Full
Needs Decluttering
Fridge interior condition
Clean
Light Soil
Moderate Soil
Heavy Soil
Not Applicable
Freezer interior condition
Clean
Light Soil
Moderate Soil
Heavy Soil
Not Applicable
Oven interior condition
Clean
Light Soil
Moderate Soil
Heavy Soil
Not Applicable
Access, Safety & Logistics
Parking instructions
Are pets on site?
*
No
Yes
Key, lockbox, and alarm details
Where are your garbage bins located for disposing of interior trash?
*
Priorities, Media & Notes
Client Priorities
*
Kitchen
Bathrooms
Floors
Windows
Baseboards
Appliances
Inside Cabinets/Closets
Move-In Prep
Move-Out Reset
Deep Cleaning
Other
Photos / Supporting Files
Upload a File
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How Did You Hear About Us?
Please Select
Referral
Google Search
Social Media
Website
Repeat Client
Property Manager
Flyer/Sign
Other
Additional Notes
Supplies acknowledgement
Safety and service condition acknowledgement
*
I understand excessive debris may require additional time or an adjusted quote
I understand biohazards may require referral to a specialized provider
I understand mould may require rescheduling or special handling
I understand pest activity may require referral or rescheduling
I understand unsafe conditions may require referral, rescheduling, or an adjusted quote
Acknowledgement & Signature
*
Submit Intake
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