In an effort to better pinpoint your housekeeping needs, we provide you with the option of Service  Plus. Simply fill out this form, click on the 'Submit Form' button, and it will be part of your permanent record with us. |
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| Name |
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| Address |
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| E-mail |
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| H Phone |
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| W Phone |
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| 1) Have you had housekeeping help previously?
Yes
No |
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| 2) Have you had any problems with previous housekeepers? If so, please indicate the ones you found most difficult: |
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Unreliable 
Untrustworthy |
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Arrived late
Poor attitude |
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Sloppy work
Left early |
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Didn't follow directions
High turnover |
| Other:
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| 3) List specific item, if any, that previous housekeepers have missed or cleaned poorly: |
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| 4) Which of the following best describes the way you would like your house cleaned? |
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I want as much of the house as possible cleaned each time - concentrate on what can be seen. |
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Speed is not crucial, but I want a very thorough job done on the basics (floors, showers, obvious dusting, etc.) |
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The details are most important to me (baseboards, picture frames, under beds, etc.) |
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Deep clean one room each time and do a good once over on the rest of the house. |
| Other (describe) |
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| 5) If you could choose one thing that says 'clean house' to you, what would it be? |
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| 6) In case everything can't be finished in the time scheduled, what are your priorities? |
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| 7) Indicate in order of priority the characteristics of a housekeeper that are most important to you: (1 - 8) |
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Follows my directions |
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Self-directed |
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Punctual |
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Dependable |
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Long-term committment |
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Fluent in English |
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Friendly |
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Businesslike |
| Other:
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| 8) Would you prefer: |
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A team of two (usually male/female) |
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An individual male |
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An individual female |
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Doesn't matter |
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| 9) List in order of preference, the day and time you would like service. |
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Mon |
Tues |
Wed |
Thurs |
Fri |
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Morning
Afternoon |
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Doesn't matter |
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| 10) If for some reason your regular housekeeper(s) is/are unable to come, can we send a substitute without calling you first? |
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Yes
No |
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| 11) Is there any other information you would like to have as part of your permanent record with us? |
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| 12) Is there someone you know who would appreciate receiving an information packet from us? |
| Name: |
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| Address: |
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| 13) Would you like to receive extra brochures for friends? |
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Yes
No If so, how many?
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