**Required Fields**

*Contact First Name *Contact Last Name

Company Name (if applicable) *Service Address

*City *State *Zip Code

Contact Numbers w/ Area Code

*Home Cell Work Email

How can we help you today? Please provide any information that will assist us in providing a cleaning estimate, including custom cleaning requirements, or any cleaning task that requires special attention.

Dwelling Type:
House Apartment Condo Office/Commercial Building Church Construction Site Other

Name of Development or Apartment Complex:

Floor Plan:
Flat Townhouse Basement Built-in Microwave Ranch House 2-Story House Patio Deck Other

Floor Type:
Linoleum Marble Carpet Stone Wood Ceramic Tile Other

Please provide the following property details:  A. Square footage. B. Number of levels. C. Number of offices or number of rooms. D. Number of bedrooms. E. Number of bathrooms. F. Number of kitchens.  G. Number of windows:

Do you need a regular clean, heavy clean, super clean or Unsure? Regular Clean Heavy Clean Super Clean Unsure

Is this an urgent service need? Please Select Yes No Sort Of How did you hear about us? Please Select Town Money Saver ThisWeek Newspaper Columbus Dispatch Newspaper Suburban News Paper Friend Sunny 95 Radio Station Smooth Jazz Radio Station B-107.9 Radio Station An Email Columbus CEO Columbus Monthly Columbus Alive Your Website Business Card Post Card SBC Yellow Pages SBC Website Yellow Book Yellow Book Website Yahoo Search MSN Search Google Search Vehicle Sign Val Pak Entertainment Book Praise Reporter eBag Referral Other   

If other please specify:

Cleaning frequency desired? Please Select Monthly Bi-Weekly Weekly Daily One Time Occasional Move In/Move Out

How long have you resided at this location?

How often was regular cleaning done at this location?
Daily Weekly Bi-weekly Monthly Seasonal Yearly Very Rare Never

Will everything be completely out of your unit?Yes No Not Applicable

Do you have ceiling fans hard to reach?Yes No

Home Repair and Improvement Needs:

Will you need moving or hauling done? Yes, quote needed No

Do you need any carpet steamed cleaned? Yes, quote needed No

Do you need any walls (drywall) repaired? Yes, quote needed No

Do you need any walls painted? Yes, quote needed No

Pet Details:

Do you have any pets? Please Select Yes No If yes, what type of pet Please Select Dog Cat Cat and Dog Other

Please list how many pets Number of occupants at Dwelling?

Is there pet poop inside the location?Yes No

Cleaning Deadline? Date you would like this done?

If you accept our quote which form of payment would you most likely use? Please Select Cash Check Credit Card Website Payment Debit Card Company Billing

Terms of Payment
Pay by check a few days before service (it has to clear the bank).
Pay with cash the day of service or by credit card the day before service.
Payment is due before the service is commenced; unless it's a commercial contract account

***Our Cleaners Gladly Accept All Tips***