Your Name (required)

Your Email (required)

Phone Number

Your Address

Frequency

Bi-Weekly (2 Times/Month for 3 Months) Monthly (For 6 Months)

Where Did You Hear About Us?

Health Care Professional Internet Penny Saver Radio Storefront Sign Car Chamber Other

Referral Name

Rooms To Be Cleaned by Priority:

Kitchen Full Bath Rooms Half Bath Rooms Hallways/Stairs Living Room Dining Room Family Room/Den Bedrooms Home Office 

Number of Bathrooms?

Numbers of Bedrooms?

Which Rooms are Priority?

NOTES:

1. Any Pets?

2. Marble or Granite(need to provide cleaners)?

3. Are your rooms mainly carpeted or hardwood?

4. On a scale from 1-10 (1 not dusty) How dusty is your home?

5. On a scale from 1-10 (1 not cluttered) How cluttered is your home?

6. Allergies to Cleaners?

7. Vacuuming needed (Leave out)?

8. Have you ever had a professional cleaning before, if so when was the last time they cleaned?

9. Times preferred for cleaning?

10. How to get in/out:

11. Anyone Home During Cleaning?:

12. Anything else you would like us to know?

NEED A NOTE FROM A DR. AT THE FIRST CLEANING OR SENT PRIOR TO IT (434 Saratoga Rd, Scotia, NY 12302)!
We usually set up appointments on Mondays (Sometimes we can fit them into a Tues or Weds)