Initial Intake Form

Client Intake Form
Customer Information
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone
Format: (000) 000-0000.
Email*
Please check all preferred days for cleanings (including the day we have you scheduled for)
Please check your preferred times of the day for cleanings
About the home

Client's Home Information
# of bedrooms*
# of bathrooms*
Approx. square foot
# of stories*
Laundry ServiceDishwashingOrganizingDeclutteringOther
Client will provide cleaning supplies.Cleaning company to provide cleaning supplies (may have an additional cost).
Special Instructions or Notes:
List tasks to exclude:
Signature

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Client Intake Form