Name * First Name Last Name Phone * (###) ### #### Email Address Address 1 Address 2 City State/Province Zip/Postal Code Country Date MM DD YYYY What are your preferred arrival times? * Anytime Morning Afternoon Evening Property Type * Residential Commercial Service Type * Standard Cleaning Deep Cleaning Move in/out Cleaning Post-Construction Cleaning Office Please Select Frequency * Weekly Every 2 Weeks Monthly One-Time How Many Bedrooms to be Cleaned 1 2 3 4 5 6 How Many Bathrooms to be Cleaned 1 2 3 4 5 6 Approximate Square Footage 0-999 1000-1499 1500-1999 2000-2499 2500-2999 3000-3499 3500-3999 4000-4499 4500-4999 5000-5499 5500-5999 6000-6499 Do you have pets that shed? * Yes No Ad-On Services Oven Cleaning Refrigerator Cleaning Window Track Cleaning Baseboard Cleaning Interior Cabinet Cleaning (Must be emptied prior) How Did You Hear About Us? * Social Media Search Engine (Google, Bing, etc) The Greater Palm Bay Chamber of Commerce Event Seniors Helping Seniors Word of Mouth Flyer/Business Card Other Please provide any additional details regarding your property (example, if this is for a business, please provide number of offices, conference rooms, etc We strive to offer precise cleaning estimates based on the details you provide and comparable homes. If extra time is necessary, we’ll seek your consent to proceed at the hourly rate. * YES, I Understand and Consent NO, I Understand but do not wish for additional time If you will not be present at time of the cleaning, do you give us permission to enter your property? * YES, I consent for ProClean Services of South Brevard to enter my property if I am unable to be present at time of the cleaning NO, I do not consent and will make arrangements for someone to be at the property during the time of cleaning Thank you!