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Residential
Commercial
Company Name
First Name/Last Name:
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Street Address:
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City:
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State:
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Zip:
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Best Phone#:
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Home
Cell
Work
Email Address:
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How did you hear about us?
*
How did you hear about us?
BNI
Brittany Black
Cesar's Carpet
Chamber of Commerce
Cleaning for a Reason
Facebook
Flyer
Friend
Google
Neighbor
Next Door App
Property Management
Queendom Networking Event
Realtor
Referral
Saw Cleaning Technician in person
Style Magazine
Unsure
Website
YELP
Have Pets?
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How soon do you need the cleaning done?
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What is the soil level from 1-10 (10 being the worst)
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Select Your Option
1
2
3
4
5
6
7
8
9
10
How many bedrooms?
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Select Your Option
1
2
3
4
5
How many bathrooms?
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Select Your Option
1
1.5
2
2.5
3
3.5
4
Do you have blinds or shutters?
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Select Your Option
Blinds
Shutters
No window coverings
Do you need inside of your refrigerator cleaned? (Move outs only)
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Select Your Option
Yes
No
When was the last time your home was professionally cleaned?
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What type of flooring do you have?
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Select Your Option
All hardwood/vinyl
Mostly carpet
Mostly hardwood/vinyl or tile with carpet in bedrooms only
What is your preferred day of the week for the cleaning to be done?
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Select Your Option
Monday
Tuesday
Wednesday
Thursday
Friday
Any day works for me!
What is the square footage?
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Will there be a gate code?
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Select Your Option
Yes
No
What is your preferred method of contact?
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Select Your Option
Text
Phone
Email
I'm interested in the following
Weekly Recurring Cleaning
Bi-Weekly Recurring Cleaning
Monthly Recurring Cleaning
Deep/Spring Cleaning
Move In or Move Out Clean
Janitorial Services
Post Construction Cleaning
Insert any additional information if needed :
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Authorization
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