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PERSONAL INFORMATION
First Name
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Last Name
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Phone Number
(*)
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E-mail
(*)
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Street Address
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City
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State
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
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Zipcode
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How Did You Hear About Us?
- Select -
Mermaid Van
Google
Referral
Angie's List
Washington Consumer Checkbook
Yelp
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Next >
HOME & OFFICE DETAILS
Cleaning Frequency:
- Select -
One-time Clean
Move-in / Move-out
Weekly
Bi-Weekly
Monthly
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Type of Unit:
- Select -
Residential
Office
Commercial
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Number of Children?
- Select -
0
1
2
3
4
5
6
7
8
9
10
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Number of Adults?
- Select -
0
1
2
3
4
5
6
7
8
9
10
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Number of Pets?
- Select -
0
1
2
3
4
5
6
7
8
9
10
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Number of stories in your home/office?
- Select -
0
1
2
3
4+
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Type of Building:
- Select -
Condo
Townhouse
Single Family Home
Duplex
Office
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Number of bathrooms to clean?
- Select -
0
1
1.5
2
2.5
3
3.5
4
4.5
5+
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Number of bedrooms to clean?
- Select -
0
1
2
3
4
5
6+
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List all additional rooms to be cleaned other than bedrooms and bathrooms:
- Select -
0
1
2
3
4
5
6
7
8
9
10
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Additonal Room Types
Foyer
Mud Room
Den
Office
Family Room
Living Room
Dining Room
Kitchen
Eat-in Kitchen
Utility Room
Exercise Room
Home TRheater
Basement Rec Room
Other (Specify Below)
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Specify Additional Rooms
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ADDITIONAL INFORMATION
Onsite Parking?
Yes
No
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Floor areas are mainly:
Carpeting
Hardwood Flooring
Laminate
Other
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Number of Window Blinds?
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None
A few
A lot
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Clutter
Yes
No
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Change of linens for how many beds?
- Select -
1
2
3
4
5
6
7
8
9
10
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Deep Quarterly Cleaning Desired?
Yes
No
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Comments
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Desired Start Date?
ASAP
1 to 2 Weeks
Doesn't Matter
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