First Name

Last Name

Phone/Mobile

Email

Address

Address Line 1

City

Zip Code

HOME DETAILS

Approximate Square Footage

Home Color / Exterior Description

Frequency of Services Needed

ACCESS & PETS

Will someone be home during the clean, or do we need entry instructions?

Pet Information (Type, number, temperament, any special instructions)

PAYMENT & REFERRAL

Preferred Payment Method

Name On Credit Card

Your Credit Card Number

Card Expiration Date

CCV 3-Digit Code

How Did You Hear About Us?

FLOORING & EQUIPMENT

Vacuum Location: (We Do Not Provide Vacuums)

LIVING AREAS / ENTRY / STAIRS

Would You Like The Living Room And Entry Areas Cleaned?

Yes

No

Any Special Requests Or Areas Of Focus?

KITCHEN

Would You Like The Kitchen Cleaned?

Yes

No

Dishes

Any Special Kitchen Requests?

BEDROOMS

Number Of Bedrooms

Would You Like The Bedrooms Cleaned?

Yes

No

Any Special Bedroom Requests?

BATHROOMS

Number Of Bathrooms

Would You Like The Bathrooms Cleaned?

Yes

No

Any Special Bathroom Requests?

LAUNDRY / MUD ROOM

Would You Like The Laundry Or Mud Room Cleaned?

Yes

No

GARBAGE

Would You Like Trash Removed From The Home?

Yes

No

If yes, where is the outdoor garbage can located?

ADDITIONAL INFORMATION

Allergies Or Sensitivities We Should Be Aware Of?

Anything Else You’d Like Your Housekeeper To Know?

VIDEO WALKTHROUGH

If at all possible, use your phone to take me on a virtual tour of your home. Pan across each room you would like us to clean. Then use the upload feature below to attach and upload the video from your camera roll.

Choose And Upload Your Video Here

Choose File

New Cleaning Job Intake Form