New Client Information Form Please fill out all categories to the best of your ability, this allows us to create a custom quote that best fits your cleaning needs! Contact InformationName First Last Date MM slash DD slash YYYY PhoneEmail Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Home DetailsWhat is the square footage of your home?How many bedrooms?How many bathrooms?How many people are living in your home?Do you have any pets? Please briefly describe. What type of Cleaning Service are you looking for?* I want to establish regular Routine Services I need a One Time Deep Clean I need a One Time Move In/Out Clean I need a One Time List Ready Clean I want my Routine Services to be scheduled:* Weekly BiWeekly Monthly What types of flooring do you have throughout your home?* Hardwood Natural Stone (Marble, Slate, Granite) Tile Laminated Vinyl Plank Carpet Which of the following best describes your home?* Sparse Neat Average Messy Packed/Cluttered Are there any areas of your home that we cannot reach with a 2 step ladder?* Yes No Please describe these hard to reach areas:*Your home is*One LevelTwo LevelsThree or more LevelsDo you have any ceiling fans and/or chandeliers that are hard to reach or hard to clean?* Yes No How many?* On a scale of 1-10, 1 being PRISTINE CLEAN and 10 being FILTHY DIRTY, where would you rate the cleanliness of your home right now?*Don't worry, we've seen it all!Please describe any special challenges you would want us to focus on*Scheduling DetailsI would prefer my cleanings to be scheduled* Toward the beginning of the week Toward the end of the week I'm flexible! I would prefer my cleanings to be scheduled in the* Morning Afternoon I'm flexible! Almost done!How did you hear about us?*GoogleYelpFacebookSign or Door KnockerNextdoorFrom a FriendOtherPlease let us know who we can thank! I certify that the information submitted is true and correct to the best of my knowledge and understand that any quote generated from this information will be subject to adjustment should any of the details I've provided prove to be inaccurate.
