Immaculate Cleaners * Cleaning Service Agreement
We hope that you enjoy our service and we encourage you to provide us with any feedback.
Name
First Name
Last Name
Appointment Date (if available)
-
Month
-
Day
Year
Date
What type of service applies to you?
First Time Appointment
One Time Appointment
Weekly Service
Bi-weekly Service
Monthly Service
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell Phone
E-mail
example@example.com
How many Bedrooms and Bathrooms do you have?
Do you have any stairs?
Please Select
Yes
No
Do you need a basic cleaning or deep cleaning?
Please Select
Basic cleaning - Sweep/Mop/Vacuum all floors; Clean all touch surfaces (counters, door knobs, handles, outside of cabinets), wipe down outside of appliances; Bathrooms ( no stain removal or shower included)
Deep cleaning: All that’s included in basic; baseboards and window seals wiped down (blinds not included);wipe down inside of all appliances and cabinets/drawers; Bathroom (remove toilet stains, clean shower)
Do you have any marks on walls that you want removed? If so, please describe where, what the stain is and how big.
Have you had a pest problem before or currently have pest in the home such as roaches, mice etc. ? If yes, please describe your pest issue. If no, please keep in mind at arrival if we feel that you do have a pest problem we have the right to decline the appointment or upcharge your price.
Please Select
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Do you have any pets? If yes, what kind of pet and will there be a lot or any pet hair that’ll need to be removed?
Please Select
1. Yes, I have pets but there isn’t any pet hair that needs to be cleaned.
2. Yes, i have pets and there will be a lot of hair to clean.
3. No I don’t have any pets.
Do you have a lot of dust or any mold?
Please Select
A little dust
No dust, but I have mold
Yes, I have a lot of dust
Yes, I have mold I’m concerned about
Please upload a video of the areas needing service:
Browse Files
Drag and drop files here
Choose a file
Cancel
of
How do we gain entrance?
Keys with office
Keys with doorman
Someone will grant access
Other
Please Upload front of ID
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Signature
In the event that we have to temporarily or permanently change your cleaning consultant, how would you like to be notified?
Please email me
Please call me
Don't email/call, I am OK with any replacements
Submit Form
Submit Form
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