Contact Information with the Address of the Home to be Cleaned:
Your name: LAST then FIRST
Your home phone number:
Alternate phone number:
Your email address:
Every Other Week
GeneralEvery 4 Weeks
Chore List Cleaning
Type of Cleaning?
Number of Adult Residents ( 17+)?
5 or more
Number of Children 16 or younger Residents?
less than 900
901 - 1300
1301 - 1600
1601 - 2000
2001 - 2500
2501 - 3000
3001 - 3500
3501 - +
Approximate Square Feet?
Number of ceiling fans:
Number of floors to be swept and washed each service:
Number of stairs to clean (not steps)
Number of windows:
Number of louvered doors (including closet doors):
Number of French doors:
Number of ceiling lights:
Number of windows with blinds or shutters:
Number of wood burning stoves or fireplaces:
Number of patio or sliding glass doors:
Number of doors:
How many dogs?
How many cats?
I dentify the condition of your home:
Pet hair level:
Clutter level (work papers, bills, counter items, etc):
Level of picking up (toys, clothes, other):
Soap scum level (in how many bathrooms?):
Specification About Cleaning Your Home
Bedrooms and Bathrooms:
Number of bedrooms to clean?
How many full bathrooms (shower and/or tub)?
How many 1/2 bathrooms?
Will we be changing the bedding?
Will we be exchanging the towels with fresh towels?
Will we be washing the towels?
If so, how many beds will we be changing?
Are we to put back the freshly washed towels?
Type of bathroom floorings (Select as many as needed by holding the ctrl key while clicking)
Type of shower area (Select as many as needed by holding the ctrl key while clicking):
Will we be washing & drying the bedding?
Number of Shower Doors:
How many sets of beding will we be washing?
Are we to put back on the bed the freshly washed bedding?
Number of bedroom floors to be washed each service:
Kitchen, Living areas and other rooms:
Kitchen: Please check one or more:
With Counter Island
With Breakfast Nook
Window Above Kitchen Sink
Stainless Steel Appliances
Stove Top Has Drip Pans
Things on counters [may be clutter]
Number of Counter Items [such as toaster, cannister set, blender and so on].
Dishes / Pans to be Washed
Other Areas Needing Cleaned (check all that apply) :
Formal Dining Room
In-Formal Dining Room
Recreation Bar Room
Other Room 1
Other Room 2
Other Room 3
Flooring including the Kitchen and Dining Areas [ -DO NOT INCLUDE BATHROOMS):
# of Rooms with Wall-to-Wall Carpeting
# of Rooms with Area Rugs
# of Rooms with Wood Flooring
# of Rooms with Quarry or Ceramic Tile
# of Rooms with Throw Rugs
# of Rooms with Linoleum, Tile or Vinyl Flooring
Number of table Lamps:
Quantity of Knick-nacks:
# bookshelf units: