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NAME
*
First Name
Last Name
PHONE
*
Format: (000) 000-0000.
E.MAIL
*
ADDRESS
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
HOW DID YOU HEAR ABOUT US?
TYPE OF CLEANING
*
Regular Cleaning
Vacate Cleaning
Rent Inspection Clean
Laundry and Light Cleaning
Rent Inspection Clean
Green Cleaning
Getting House Ready to sell
Spring Cleaning
Bathroom cleaning
Other
SPRING CLEANING OPTION
No
Basic Spring Cleaning
Premium Spring Cleaning
Deluxe Spring Cleaning
REGULAR CLEANING OPTIONS
*
Weekly
Fotnightly
Monthly( every 4 weeks)
Quarterly( every 3 months)
Seasonal
DO YOU NEED EXTRA CALCIUM REMOVAL CLEAN ON SHOWER SCREEN
*
Yes(I'll pay extra)
No
DO YOU NEED BLINDS CLEANING?
*
Yes(dusted only)
Yes(Dusted and Hand wiped and washed)
No
WILL YOU NEED CARPET CLEANING?
*
Yes
No
WILL YOU NEED WINDOW CLEANING?
*
Yes
No
WALL CLEANING( 1 CLEAN TO 5 VERY VERY DIRTY)
*
1
2
3
4
5
Tell us a little bit about your home
SIZE OF HOME
*
2X1
2X2
3X1
3X2
4X2
4X3
5X2
5X3
EXTRA ROOMS
*
study
Theater
Activity
Office
Dinning
Family
None
UPLOAD PICTURE OF HOUSE PLAN IF NEEDED
Browse Files
Cancel
of
DO YOU HAVE PET S WITH LOTS OF PET HAIRS ON FLOORS
No
Yes a little
Yes medium
Yes a lot
PROPOSED CLEANING DATE.
-
Month
-
Day
Year
Date
DICOUNT CODE
REFERRAL PERSON
COMMENTS
Save
Submit
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