Name

Address

Phone

Mobile

Email

Preferred method of contact

It would be helpful if you could provide the following information:

Are you looking for:

1

Full home clean?

Just certain rooms?

For ‘Just certain rooms’ please state how many rooms you would like cleaned?

Weekly cleaning

Monthly cleaning

How often:

2

Two weekly cleaning

Flat

Bungalow

House

Type of home:

3

Other, please specify

4

Number of bedrooms

Number of rooms, other than bedrooms

5

Number of bathrooms

6

Number of occupants

7

Number of floors (levels)

8

No

Yes

Do you have a fully functioning vacuum cleaner?

9

Thank you for taking the time to provide this information.

Town

Postcode

*

*

*

Please enter all fields with a “*” next to them, to enable us to be able to contact you. If you enter a mobile or email as your preferred contact we will use these to contact you, not the phone number.

*

If more, please specify

If more, please specify

If more, please specify

If more, please specify

If more, please specify