RBA CLEANING REGISTRATION

Name

PrefixFirst NameMiddle NameLast NameSuffix

Phone Number

Area CodePhone Number

Would you like us to text you?

YesNo

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

HOW MANY BEDROOMS?*

Studio/1 Bedroom2 Bedroom3 Bedroom4 + Bedrooms

HOW MANY BATHROOMS?*

Date

Dates are based on availability*

Desired Appointment Time 10a.m.-6p.m.

:HourMinutesAM/PM Option

How many cleans do you need this month?*

What are your desired cleaning needs?

We offer a multitude of services catered to your eminent needs.

This authorization is made between client and Emillien LLC. (Hereafter known as the Contractor). The Client desires to have certain cleaning, housekeeping, and/or janitorial services, described below, and performed upon the Client’s premises. Therefore, the parties hereby agree as follows:

1. Client shall grant Contractor access to the residence and its surroundings during regular business hours and other mutually agreeable times.

2. Recurring cleans rendered on a monthly basis are agreed upon the selection made by client during registration process.It is understood that it is of the client’s responsibility to schedule any cleanings. Cleanings do not roll over to the next month and will be forfeited.
3. You authorize regularly scheduled charges to your credit card. A receipt for each payment will be provided to you via email and the charge will appear on your credit card statement. You agree that no prior-notification will be provided unless the date or amount changes, in which case you will receive notice from us at least 10 days prior to the payment being collected. It is understood that all charges come with a 3.4% transaction service charge.

3. Client shall pay Contractor chosen recurring clean fee on the first day of each month for services to be performed during the rest of that month. Payment for services shall be rendered in the form of credit/debit card draft. If initial services are rendered after the 1st of the month, a pro-rated amount will be charged.
4. I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify Emillien LLC in writing of any changes in my account information or termination of this authorization at least 15 days prior to the next billing date. If the above noted payment dates fall on a weekend or holiday, I understand that the payments may be executed on the next business day. I acknowledge that the origination of Credit Card transactions to my account must comply with the provisions of U.S. law. I certify that I am an authorized user of this Credit Card and will not dispute these scheduled transactions; so long as the transactions correspond to the terms indicated in this authorization form.

By clicking the submit button I agree to the terms and conditions.

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