First Name *
Last Name *
Phone Number
E-Mail *
Street Address
City
Zip Code
List a specific item, if any, that previous housekeepers have missed or cleaned poorly
If you could choose one thing that says what a ‘clean house’ is to you, what would it be?
In case everything can’t be finished in the time scheduled, what are your priorities?
Check the characteristics of a housekeeper that are most important to you
Follows my directions
Self-directed
Dependable
Punctual
Fluent in English
Long-term commitment
Friendly
Businesslike
Please select the day you would prefer your housekeeping service Monday Tuesday Wednesday Thursday Friday
Please select the time of day you would prefer your housekeeping service Morning Afternoon Doesn’t Matter
Frequency (Monthly, BiWeekly, One Time) *
Number of Bedrooms
Number of Bathrooms
What is the square footage of your home? 800-1600 1700-2200 2300-2700 2800+
How Did You Hear About Us? Internet Search Social Media Referral Returning Customer
Any Other Comments?
Please note: If you are requesting that the housekeepers not wear shoes in your home, please provide booties. Due to sanitary concerns, the housekeepers’ preference is to wear shoes while cleaning bathrooms.
4 + 3 = ? Please prove that you are human by solving the equation *
