1933 Highway 35 #347, Wall, NJ 07719
732-922-2919
Mon-Sat.: 9:00 am – 5:00 pm
jim@krystalclean.com
Residential & Commercial Cleaning Experts!
8:00am - 5:00pm Mon. - Sat.
Call us at:
732-922-2919
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Name
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First
Last
Address
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Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Email
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Cell Phone
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Home Phone
(Required)
TYPE OF CLEANING
What Type of Cleaning Do You Need:?
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Weekly
Bi-Weekly
Monthly
One-Time
Move-In
Move-Out
Construction
Preferred Cleaning Time
(Required)
Morning
Afternoon
Anytime/Flexible
Home During Cleaning
(Required)
Yes
No
Need Cleaning Before A Certain Date
(Required)
Yes
No
If Yes, Select Date:
MM slash DD slash YYYY
CLEANING INFORMATION (Be Specific)
Basement Cleaned:
(Required)
Yes
No
If Yes, List All Rooms You Need Cleaned and Floor Type:
Describe Flooring in Home :
(Required)
Example: Carpet Upstairs, Wood and Carpet Downstairs.
Total Levels in Home:
(Required)
1
2
3
4
5
Do not include basement.
Kitchen:
(Required)
Yes
No
Center Island:
(Required)
Yes
No
Stainless Steel Appliances:
(Required)
Yes
No
What Material Are Countertop Surfaces:
(Required)
Total Bedrooms:
(Required)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Total Baths:
(Required)
1
1.5
2
2.5
3
3.5
4
4.5
5
5.5
6
6.5
7
7.5
8
8.5
9
9.5
10
Do you want us to use Clorox/Bleach in bathrooms?
Yes
No
Number of Offices:
(Required)
1
2
3
4
5
None
Double Staircase:
(Required)
Yes
No
List All Other Rooms You Want Cleaned:
(Required)
ADDITIONAL QUESTIONS:
Approximate square feet of home:
(Required)
Change Bed Sheets:
(Required)
Yes
No
If Yes, How Many Beds:
Do You Have Pets:
(Required)
Yes
No
If Yes, How Many & What Kind:
Are There Areas You'd Like Our Crew To Concentrate On:
(Required)
Yes
No
If Yes, Please Explain:
Additional Comments
How Did You Hear About Us:
(Required)
Client
Friend
Angie's List
Saw Our Truck
Internet
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