* First Name
* Last Name
Apt / Suite
* Address
* City
* Zip Code
*Day time Phone #
*Evening Phone #
Email:
Select one
Apartment
Condo
House
Town House
Business
Type of Home Being Cleaned:
Select one
House Cleaning Only
Carpet Cleaning Only
Upolstery Cleaning
Both House and Carpet Cleaning
Other Cleaning, Use Comment Form
Type of Cleaning Service
:
Select one
1
2
3
4
5 or more
Select one
1
1.5
2
2.5
3
3.5
4 or more
How many Bedrooms?
:
Bathrooms?:
Select one
100-400
400-600
600-800
800-1000
1000-1200
1200-1500
1500-2000
2000-2500
2500-3000
3000-4000
4000 and up
Not Sure
Square Footage
:
ENTRY INFORMATION:
DOOR WILL BE OPEN?
KEY UNDER MAT?
SEE MANAGER FOR KEY?
DAY
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
YEAR
2009
2010
MONTH
January
Feburary
March
April
May
June
July
August
September
October
November
December
DATE OF APPOINTMENT
TIME
8-9 AM
9-10
10-11
11-12
12-1pm
1-2
2-3
3-4
After 4
TIME OF APPOINTMENT
One Time
HOW OFTEN DO YOU NEED SERVICE
Once a Week
More then Once a Week
Bi-Monthly
Monthly
COMMENTS or any additional details about your cleaning estimate:
