First Name

Last Name

Name of Company

Street Address

City

Zip Code

State

Daytime Phone

Email

How did you hear about us?

Approximate Square Footage?

Frequency of Cleaning?

How many days a week do you need cleaning?

Do you need the cleaning of your office completed during the day, night, or weekends?

Number of Bathrooms?

Number of Offices?

Type of Flooring

Kitchen/Breakroom yesno
Type of Flooring

Do you have any other rooms you would like cleaned (Conference Rooms, Cubicle Areas, etc)?

On a scale from 1-10, 1 NOT dusty, how dusty is your office?

On a scale from 1-10, 1 NOT cluttered, how cluttered is your office?

Have you had a professional cleaner before? If so, when was the last cleaning?

Any questions or special considerations you may need:

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