DCCI New Customer Registration Form
Full Name
*
First Name
Last Name
Villa Complex Name
*
Villa Unit Number
Villa Name
Door Code or Lock box Code (if applicable)
Type of Billing Preferred
Please Bill After Each Clean
Please Bill Monthly
Property Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Billing Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
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Phone Number
*
Cell Phone
Home Phone
Work Phone
Secondary Phone Number
Cell Phone
Home Phone
Work Phone
E-mail
*
Number of Bedrooms
*
Number of Bathrooms
*
Type and Number of Beds
*
ex: King, Queen, Full, Twin, etc
Sleeper Sofa (please refer to quote about our sleeper set policy)
*
Yes
No
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Type of Cleaning Required
*
Residential General Cleaning
Short Term Rental Cleaning
Office Cleaning
Other
Amenities Package
*
Standard
Premium
Beach Towel Service
4 Towels @ $25.00
10 Towels @ $50.00
Square Footage of Property
*
Any Special Requests
How did you hear about us?
Please Select
Newspaper
Internet
CH2/CB2
Pink Magazine
Other (Please specify...)
Submit Application to DCCI
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