Full Name * :

Home Phone :

Mobile Phone *:

Other Phone:

Email Address * :

How did you hear about us? (If website, please specify how you found our website)

Home type (condo/apt/house/mobile home/other)

Address:

Unit #:

City:

Zip Code:

Number of bedrooms:

Number of bathrooms:

Living Room * :
Yes
No

Family Room * :
Yes
No

Kitchen * :
Yes
No

Any additional rooms in the home? Describe

Any rooms that will be skipped:

Is this for a move out or special occasion?

Any special cleaning notes or comments:

1st Choice Service Date *:

2nd Choice Service Date *:

Arrival Window:
8am-12pm11am-3pm

Any special home access notes:

Note: After you click submit, you will be taken to Paypal to enter your credit card information. Your credit card will be charged a $45 non-refundable deposit which will apply towards the cost of your maid. The remaining balance will be charged to your credit card after your maid is finished. We require 48 hours notice for cancellations and rescheduling otherwise your $45 deposit will be forfeited.