Client Cleaning Service Request

Cleaning Service Request Form

Thanks for contacting Luminaclean Facilities Services LTD. How may we help?
Customer Information
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone

Area CodePhone Number
Email
What type of cleaning service are you looking for?
Is this a one-time service or regular/ongoing?
Pick a date for our pre-clean assessment visit.

MonthDayYear
Date
Pick a time for our pre-clean assessment visit.

Hour Minutes

AM/PM Option
Type of property
About the property

Client's property Information
# of bedrooms
# of bathrooms
# of Kitchen/dinner
Approx. square foot
# of offices/work spaces
Do you have any Pets?
Additional Services

Other
Cleaning Supplies:
Special Instructions or Notes:
List tasks to exclude:
Signature
Should be Empty: