Residential Information Form

First Name:     

Last Name:     

Address:         

Unit/Apt. #:      

City, St, Zip:    

Home Telephone: 

Work Number:      

Cellular Number:  

Fax Number:        

Email:                   

Type of Property:           Choose One Apartment Condo Single Twin Townhouse

Number of Bedrooms:  Choose One 1 2 3 4 5 6 7 8 9 - Up

Number of Bathrooms:  Choose One 1 1-1/2 2 2-1/2 3 3-1/2 4 4-1/2 5

Living Room:                  Choose One Yes No

Type of Living Room Flooring:  Choose One Hardwood Some hardwood/some carpeting All Carpeting Other

Dining Room:                              Choose One Yes No

Type of Dining Room Flooring:  Choose One Hardwood Some hardwood/some carpeting All Carpeting Other

Den/Office:                                  Choose One Yes No

Type of Den Flooring:                Choose One Hardwood Some hardwood/some carpeting All Carpeting Other

Kitchen Flooring:                        Choose One Ceramic Linoleum Other

Recreation Room/Basement:  Choose One Yes No

Type of Recreation Room Flooring:  Choose One Hardwood Some hardwood/some carpeting All Carpeting Other

Frequency of Cleanings:            Choose One Weekly Bi-Weekly Other

I would like to be contacted by:  Choose One Phone Fax Email Stamped Mail

Price quote will be provided after walk thru