| Name |
|
| Email |
|
| Address |
|
| City |
|
| State |
|
| Zip |
|
| Day Phone |
|
| Work Phone |
|
| Time Table For Cleaning |
|
| Carpet Cleaning |
|
| Please enter the approximate square footage of each room |
| Family Room Sq.Ft. |
|
| Living Room Sq.Ft. |
|
| Dining Room Sq.Ft. |
|
| Master Bedroom Sq.Ft. |
|
| Bedroom 1Sq.Ft. |
|
| Bedroom 2Sq.Ft. |
|
| Bedroom 3Sq.Ft. |
|
| Bedroom 4Sq.Ft. |
|
| Bedroom 5Sq.Ft. |
|
| Hall Sq. Ft |
|
| Stairs (Number of steps) |
|
| Room 1 |
|
| Room 2 |
|
| Room 3 |
|
| Room 4 |
|
| Stain Removal Please give |
|
| Stain |
|
| Furniture Cleaning |
| Please provide details of furniture to be cleaned. 1. What color? |
|
| Please tell us how you heard of our company |
|
| For other please explain here |
|
| Actual charges will be based on our final measurments once in your home |
| |
|
