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First Name *

Last Name *

Phone Number

E-Mail *

Street Address

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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?

Follows my directions

Self-directed

Dependable

Punctual

Fluent in English

Long-term commitment

Friendly

Businesslike

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Please select the time of day you would prefer your housekeeping service MorningAfternoonDoesn’t Matter

Frequency (Monthly, BiWeekly, One Time) *

Number of Bedrooms

Number of Bathrooms

What is the square footage of your home? 800-16001700-22002300-27002800+

How Did You Hear About Us? Internet SearchSocial MediaReferralReturning Customer

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