Cleaning Client Information Form

Name

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Home Phone

Email*

Preferred Phone

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

TextEmail

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:

Client will provide cleaning supplies.Cleaning company to provide cleaning supplies (may have an additional cost).

Special Instructions or Notes:

List tasks to exclude:

Signature