Untitled Document
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New Customer Data Sheet
First Name
Last Name
Preferred Phone Number
Secondary Phone Number
Email
Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Best time to contact you
ASAP
Morning
Afternoon
Evening
Preferred contact method
Phone
Email
No Preference
How did you hear about us?
TV Ad
Google Search
Yahoo Search
Yahoo Local
Other Search Engine
Internet Yellowpages
Door Hanger
Friend Referral
Apartment Office
Newspaper Ad
Email Ad
Divine Intervention
Other
Type of Residence
House
Apartment
Townhouse
Duplex
Office
Beds
1
2
3
4
5
6
Baths
1
1.5
2
2.5
3
3.5
4
4.5
5+
Frequency
Weekly
Bi-Weekly
Monthly
One Time
Move In/Out
Type of cleaning needed
Gold Star Cleaning Service (Basic Cleaning)
Platinum Cleaning Service (Deep Cleaning)
Move In/Move Out Cleaning
Hourly Cleaning Service
Clean inside refrigerator?
Yes
No
Not Sure
Clean inside oven?
Yes
No
Not Sure
Vacuum Furniture?
Yes
No
Not Sure
If 'yes', please list items
Number of Pets
Approx. Square Feet
How many levels will we be cleaning?
Special Instructions