Name:
E-mail address:
Company Name:
Phone Number:
Are you currently one of our clients:
If yes, which service did you use last time?:
Where you referred by a friend?:
If yes, who referred you?:
Reason for Contacting Us:
Do you wish to receive our Newsletter?:
YesNo
Which Service?:
Standard cleanDeep cleanSpring cleanPet MindingDeclutter and OrganizingOther service
How did you found out about us?:
County:
Suburb:
One time, Regular clean or Special Request:
One time clean Regular clean Special Request
Preferred day & time:
Square feet:
No of bedrooms: No of bathrooms:
Do you have a bonus room?:
Do you have a formal dining room:
Please answer the following as applies:
Hardwood/Tile: Yes Have carpet: Yes
Stairs:Yes
Pets: Yes
Type of pets:
Excess Dust/Dirt:
YesSomeNo
Please select additional tasks required:
Changing linen Tidying, straightening, pickup up, putting away etc Cleaning dishes Emptying trash Steam clean floors
Comments and other information:
(Please add all additional information for your clean)
