New Customer Contact Form

NEW CUSTOMER CONTACT FORM

* Indicates required field

Business Name *

First

Last

Address *

Contact Name *

First

Last

Phone Number *

Email Address for Quote *

Approx. Size of Bldg. in Sq. Ft. *

No. of Rooms or Offices *

Type of Flooring (all that apply) *

Carpet Tile Hardwood Laminate Stained Concrete Linoleum Vinyl

No. of Bathrooms *

Are there any Stairwells? *

No. of Stalls/Bathroom (if applicable) *

Frequency of Cleaning *

Once Monthly Once Weekly As Needed One Time Clean OTHER (See Notes)

Has Customer Requested That We Provide Paper Products? *

Preferred Time and Day for Cleaning *

Extra Services *

Initial Deep Clean Laundry Windows

NOTES *

NOTES: *

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