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Cleaning Service Form
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Step
1
of 3
Client Information
Name
*
First
Last
Email
*
Phone
Home Address
Address Line 1
Address Line 2
City
State / Province / Region
Postal Code
Next
Cleaning Services
Select your Cleaning Service
Select Services
House Cleaning (Regular)
Commercial Cleaning
Carpet Cleaning
Domestic Clinic
Deep Cleaning
Window Cleaning
Mattress Cleaning
Next
When we come to your home?
One time
Weekly
Monthly
Select Hours with materials requirments
*
Use Our Materials – $45.00
Use Your Materials – $35.00
2
3
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5
6
7
8
9
10
Price Depends on the selection of choices and hours. e.x. If you select Use our materials with 2 hours then price will be $90.00 (per hours charge is $45.00)
Select hours for Monday
*
Select day – $0.00
Monday – $30.00
0
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9
10
Date / Time
*
Date
Time
Select hours for Tuesday
*
Select day – $0.00
Tuesday – $30.00
0
1
2
3
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5
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8
9
10
Date / Time
*
Date
Time
Select hours for Wednesday
*
Select day – $0.00
Wednesday – $30.00
0
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3
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9
10
Date / Time
*
Date
Time
Select hours for Thursday
*
Select day – $0.00
Thursday – $30.00
0
1
2
3
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5
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7
8
9
10
Date / Time
*
Date
Time
Select hours for Friday
*
Select day – $0.00
Friday – $30.00
0
1
2
3
4
5
6
7
8
9
10
Date / Time
*
Date
Time
Select hours for Saturday
*
Select day – $0.00
Saturday – $30.00
0
1
2
3
4
5
6
7
8
9
10
Date / Time
*
Date
Time
Select hours for Sunday
*
Select day – $0.00
Sunday – $30.00
0
1
2
3
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8
9
10
Date / Time
*
Date
Time
Select Month for Cleaning
Jan
Feb
Mar
come Layout
Select Days for Cleaning
*
Monday
Tuesday
Wednesday
Select Date / Time
*
Date
Time
Select Hours
*
Deep Cleaning Services
Deep Cleaning Services (Fixed Price) –
$400.00
Including three- rooms, Washroom, Kitchen and others extra charges
Bedrooms
*
Touch-up Job – $20.00
Deep Cleaning – $50.00
0
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10
Bathrooms
*
Touch-up Job
Deep Cleaning
0
1
2
3
4
5
6
7
8
9
10
Living Spaces
*
Touch-up Job
Deep Cleaning
0
1
2
3
4
5
6
7
8
9
10
Kitchen
*
Touch-up Job
Deep Cleaning
0
1
2
3
4
5
6
7
8
9
10
Outdoor Areas
*
Touch-up Job
Deep Cleaning
0
1
2
3
4
5
6
7
8
9
10
Garage
*
Touch-up Job
Deep Cleaning
0
1
2
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8
9
10
Special Instructions
*
Payment
Total Amount
Order Summary
Item
Quantity
Qty
Total
There are no products selected.
Select Hours with materials requirments – Use Our Materials
2
$90.00
Select Hours with materials requirments – Use Your Materials
2
$70.00
Select hours for Monday – Select day
0
$0.00
Select hours for Monday – Monday
0
$0.00
Select hours for Tuesday – Select day
0
$0.00
Select hours for Tuesday – Tuesday
0
$0.00
Select hours for Wednesday – Select day
0
$0.00
Select hours for Wednesday – Wednesday
0
$0.00
Select hours for Thursday – Select day
0
$0.00
Select hours for Thursday – Thursday
0
$0.00
Select hours for Friday – Select day
0
$0.00
Select hours for Friday – Friday
0
$0.00
Select hours for Saturday – Select day
0
$0.00
Select hours for Saturday – Saturday
0
$0.00
Select hours for Sunday – Select day
0
$0.00
Select hours for Sunday – Sunday
0
$0.00
Deep Cleaning Services – Deep Cleaning Services (Fixed Price)
1
$400.00
Bedrooms – Touch-up Job
0
$0.00
Bedrooms – Deep Cleaning
0
$0.00
Living Spaces – Touch-up Job
0
$0.00
Living Spaces – Deep Cleaning
0
$0.00
Outdoor Areas – Touch-up Job
0
$0.00
Outdoor Areas – Deep Cleaning
0
$0.00
Bathrooms – Touch-up Job
0
$0.00
Bathrooms – Deep Cleaning
0
$0.00
Kitchen – Touch-up Job
0
$0.00
Kitchen – Deep Cleaning
0
$0.00
Garage – Touch-up Job
0
$0.00
Garage – Deep Cleaning
0
$0.00
Total
$90.00
$0.00
Confirmation
*
I acknowledge that I have read and agree to abide by the the Terms and Conditions
I acknowledge that upon submitting this form, my orders are final and can no longer be canceled
Stripe Credit Card
*
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