EmailMe Form - Online Consultation

Name *
First Last
Email *
Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Phone *
### - ### - ####
Frequency of Cleaning *

How often do you want cleaning service
How many square feet is your home? *
How many stories is your home? *
How many full bathrooms do you have? *
How many half bathrooms do you have? *
Do you have any pets? *
Type of flooring

Check all that apply

Carpet

Wood

Tile

Linoleum

Laminate

Other
How many bedrooms do you have?
How would you rate the level of dirt in your home?

How often do you want cleaning service

The Bathroom

	Very Clean no problem areas	Medium level of dirt, stains, mold, hard water, soapscum	Heavy mold, stains. mildew, hard waster and soapscum
Shower Door
Tile with Grout Walls
Marble/Stone Walls
Acrylic
Tub
Toilet

	Clean	Dusty	Soiled (lookslike there is stuck on dirt that would require washing)
Blinds
Window Sills
Baseboards