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Service Ordering For Home Cleaning

Please fill in your information: New Customer   Existing Customer

Gender :   Miss   Mrs   Mr

First Name :
Last Name :
Contact Phone :
Email Address :
Fax :
Service Address :
Gross Size of the apartment / house
Square feet   Square meter
How did you know about us?

Please select the service you would like to order in the following:

Please select the time slot:
Morning shift (9:00a.m. to 1:00p.m.)
Afternoon shift (2:30p.m. to 6:30p.m)

Frequency :
Daily 3 times a week 2 times a week
Weekly Bi-Weekly Monthly

Any preference on the day?
Mon Tue Wed
Thur Fri Sat

New Customer please select the service you wish to subscribe:
Number of Service Price Average price per visit
       1 time $400 $350
(First Service Discount)

Will you leave key? Yes    No

Do you need ironing service? Yes    No

Any pets at home? Yes    No

Any other special request?

Please select the commence service date:

List of cleaning priorities, if any

*Payment Terms: Deposit to bank account    Cheque

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