Maid to Perfection® Service Request Form

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 Perfection®?:

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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