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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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Best Phone#:
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Home
Cell
Work
Email Address:
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How did you hear about us
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How did you hear about us?
Facebook
Flyer
Friend
Referral
Unsure
word of mouth
Yellow Pages
What type of cleaning are you interested in?
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Select Your Option
Residential Deep Cleaning
Residential Recurring Maintenance Cleaning
Residential Kitchen, Bathrooms & Floors Package
Office / Commercial Cleaning
How many bedrooms are in your home ?
*
How many bathrooms are in your home ?
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Approximately how many people live in the home?
*
Do you have pets ? If so how many & type of pet
*
How would you describe the current level of cleaning needed in your home?
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Select Your Option
Light — regularly maintained with minimal buildup
Moderate — some dust, grime and buildup in areas
Significant — noticeable buildup and areas needing extra attention
Heavy — substantial buildup throughout the home
Have you had professional cleaning services before?
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Select Your Option
Yes, currently
Yes, in the past
No, this will be my first time
Insert any additional information if needed :
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