Name
*
First Name
Last Name
Email
*
Phone
(###)
###
####
Location for Services
*
Please provide the address for the location we will be servicing.
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Billing Address
(If different from service location)
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Parking Instructions
*
Please provide instructions on where to park and any other relevant information e.g. visitor parking, visitor pass needed, paid parking lot nearby etc.
Entry Instructions
*
Please provide specific details about entry to your location. e.g. use front/back/side door, door/buzzer codes, access entry via etc.
Preferred Day and Time of Service
*
Please provide your top three choices
Preferred Frequency of Service
*
Weekly
Bi-weekly
Monthly
Bi-monthly
One time only
Are there any pets at the service location?
*
If "yes", please provide more details.
e.g. number and type of pets
Are there any allergies or sensitivities we should be aware of?
*
If "yes", please provide more details.
e.g. products to be avoided
Where are your recycling, garbage, and compost located?
*
What supplies are on site and where are they located?
*
Please provide us details on which supplies and stock will be available and where your service provider can find them.
Do linens and towels need laundering during the service?
*
If "yes", please provide more details.
e.g. location of clean linens and towels, laundry facilities and care instructions.
Please identify which of the following areas will need servicing
*
Check all that apply
How many bathrooms will need servicing?
*
1
1.5
2
2.5
3
3.5
4
4.5
5+
How many kitchens will need servicing?
*
1
2
3
How many bedrooms will need servicing?
*
1
2
3
4
5
6
How many levels does the service location have?
*
Are there any specific needs we should be aware of?
*
e.g. mobility
Are other in-home support services being provided currently?
*
e.g. nurse, physiotherapist
Is there anything else you’d like to share with us regarding your cleaning service?
