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First Name
　

Last Name
　

email

Cell phone numbers / Work phone / Home phone

Current home address (location for cleaning)

Do you have a house pet? If yes, what type is it?

How many bedrooms and bathrooms are there in your residence?

How can we get inside your residence for cleaning? Will you be there to let the housekeeper in or will you leave a hidden key?

What is the month and year of your PCS?

What are the areas of priority for cleaning?

How often would you like to utilize our services, once a week, twice a month, once a month, etc.?
once a weektwice a monthonce a monthNot Applicable

How many hours would you prefer to take ? for 2 hours is $60.00, 3 hours $75.00 or 4 hours $95.00 ?
4 hours $95.003 hours $75.002 hours $60.00Not Applicable

What type of cleaning would you like to order for the initial cleaning? deep cleaning $185.00, triple cleaning $265.00 or basic cleaning $95.00 ?
Triple cleaning $265.00Deep cleaning $185.00Basic cleaning $95.00

What type of floors do you have? (wood, tile, marble, linoleum, etc.)

How did you know about us?

Do you have parking space for the housekeeper while they are working?

Note

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