Name
*
First Name
Last Name
Email
*
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
(###)
###
####
Do you have a coupon code or gift card?
Yes
No
Enter coupon code or gift card # here:
Have you applied for our income based program?
Yes
No
Not yet
Available discounts:
Low Income
Retired
Teacher
Student
Essential Worker
First Responder
Veteran
None
Number of bedrooms
Number of bathrooms
Approximate square footage
Does anyone smoke inside the home?
Which areas of your home are you most concerned about?
Is there anything specific in your home that you don’t want moved or touched?
Do you have a preference for scents or types of products used in your home?
Check of all rooms/types of services you are interested in.
*
This is not an exhaustive list of services, it is intended to give us a rough idea of what your needs are.
Do you have any children? If so, please let us know if any of your children are crawlers or have special accommodations or needs? (Like not to use the doorbell, etc.)
Do you have any pets? If so, what type, what are their names, and where will they be located while we're cleaning?
Will you be home at the time of service? If not, please provide a door code, garage code, location of a hidden key, or how you would like the housekeeper to gain entry into your home.
Where is the best place for your housekeeper to park?
Are you interested in a one time clean, or recurring cleaning services? If you're interested in recurring services, how frequently would you like your housekeeper to come to your home?
Which day of the week do you prefer?
Which day would be your second preference?
Which time of day do you prefer?
How many hours do you think it will take to complete the cleaning and services you’re interested in?
Please choose your preferred start date.
We cannot guarantee this will be your start date.
MM
DD
YYYY
Please feel free to share anything else with us that you feel may be useful:
