Personalized Cleaning Form

Please fill out this easy to use form.
Please provide your contact information.

First Name
Last Name
Street Address
City
State
Zip Code
Phone Number
E-mail Address
Square Footage of Residence
How Many Levels?
Are the utilities on?
Is the residence furnished?
What would you like to be done?
Would you like the contents dusted or fully cleaned?
What is the level of soiling (1 being the lightest soil, 10 being heavy soiling)
Are there any high ceilings?
Any special conditions (odor, urine, nicotine, mold)?

Please check all rooms that apply.

Please give the specifics on the following:

Clean Stove
Clean Refrigerator
Other Appliance
Area Rugs
Blinds, Shades
Cabinets
Carpets
Ceiling Fans - How Many?
Ceilings
Dusting
Hard Surface Floors
Furniture
Type of Heat
Would you like all horizontal surfaces cleaned?
Lights
Trash Removal - How many bags? Is a dumpster needed? Does not apply?
Trim and Woodwork
Upholstery
Windows (Inside Only) - How Many?
Walls
Other

If you would like carpets, upholstery, area rugs or blinds/shades cleaned, please provide the following information.

Carpet Cleaning: Room Sizes
Upholstery: Type and Number
Area Rugs: Type and Sizes
Blinds, Shades: Type and Number