Cleaning Client Information Form

Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Home Phone

Format: (000) 000-0000.

Email

Preferred Phone

What type of reminder would you like to receive for each service?

Please check all preferred days for cleanings (including the day we have you scheduled for)

Please check your preferred times of the day for cleanings

# of bedrooms

# of bathrooms

Approx. square foot

# of stories

More than 50% carpeted

Additional Services

Cleaning Supplies:

Special Instructions or Notes:

List tasks to exclude:

Signature