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The Human Touch Cleaning Co. – New Customer Request Form

Reliable Cleaning. Personal Service.

Customer Information

First name*

Last name*

Phone number*

Email address*

Property Address

Property address

Country/Region*

Address*

City*

Zip / Postal code*

Cleaning Service Details

Type of service needed*

Preferred cleaning date*

Preferred time*

Morning

Afternoon

Flexible

Home Details

Number of bedrooms*

Number of bathrooms*

Approximate square footage*

Home Condition

Last professional cleaning

Home condition*

Light

Moderate

Heavy

Pets in the home*

Yes

No

Type of pet

Additional Services

Select any additional services needed

Inside Refrigerator

Inside Oven

Interior Cabinets

Interior Windows

Baseboard Deep Clean

Laundry Folding / Organization

Garage Sweep / Tidy

Special Instructions

Entry instructions

Areas needing extra attention

Areas you do NOT want cleaned

Agreement

I understand pricing may vary depending on the size and condition of the home. Final quotes will be provided before service is scheduled.

Contact: thehumantouchcleaningco@gmail.com

Serving Riverside County and San Bernardino County | Email: thehumantouchcleaningco@gmail.com

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