Residential Cleaning Services








    On-Line Customer Service Form

*Required fields in red
*Each checklist must have at least one box checked.*
Date:
Time:
Name:
Address:
City:
 State:  Zip:
Day Phone:
Evening Phone:
Best Time to Call You During Day: (Please select AM or PM)
  AM   PM
E-mail Address:

Service Frequency: (Please check one)
Weekly     Bi-Weekly     3 Weeks
4 Weeks     Monthly     Occasional     One-Time

Areas Needing Cleaning in Your Home:

Total Square Footage:

Total Bedrooms:    Total Bathrooms:
Kitchen: (Please check one or more)
Efficiency    Standard
Eat-In    With Breakfast Nook
Basement: (Please check one)
Finished    Unfinished    N/A
Does Your Home Have: (Please check one or more)
Office    Study    Den    Library
Family Room    Living Room    Dining Room   
LR/DR Combo    Foyer    Loft   
Garage    Mud Room
Other(s):

# of Rooms with Wall-to-Wall Carpet   With Wood Floor
With Linoleum/Tile   With Quarry Tile
# of Ceiling Fans   # of Cathedral Ceiling Areas
Windows Need Cleaning: (Please check one)
Inside    Outside    Both N/A

How did you hear about Maid to PerfectionŽ?:
May we e-mail you special promotions and coupons?: (Please check Yes or No)
Yes   No
Comments:

OR ONE CALL CLEANS IT ALL!
Dial 1-888-MAIDUSA (624-3872) to Be Linked
Directly to Your Local Service Office Toll-Free
(In Canada Call 1-877-MAIDCAN)

FREE "TOTALCLEAN" CONSULTATION





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