Complete this form to receive an estimate cost for
cleaning an occupied residential dwelling.
Please refer to the Standard Service Checklist for what this service includes.
free estimate for standard service
Last Name
First Name
 M.I.
Spouse's First Name
 M.I.
 Spouse's Last Name
Service Address
City
 State
 Zip Code
please list a major intersection closest to your home
Mailing Address (if different than Service Address)
State
City
 Zip Code
(Area) Home Phone
 (Area) Work Phone
 (Area) Mobile Phone
E-Mail Address
How would you like to receive this information?
Select all that apply
By Home Phone
By Work Phone
 By Mobile Phone
By U.S. Mail
By E-Mail
type of service
 Preferred
day
(SUBJECT TO
AVAILABILITY)
Hold the Control button to make  
multiple selections.
What date do you need service?
what is the size of the dwelling?
how many floors (stories)?
how many rooms to be cleaned?
How many bedrooms?
How many bathrooms?
How many residents?
How many indoor pets?
Are the pets allowed outside?
YES
 NO
what percentage of home has
hardwood flooring?
please list rooms to be excluded
do you have any specific instructions?  
(i.e. your expectations, room exclusions, additional services needed,
how your hardwood floors are cleaned or any other special circumstances)
please help us track our advertising by
telling how you found out about our service.
Select all that apply
bellsouth
yellow pages
referral
yellow pages.com
verizon/idearc
yellow pages
google search
other
yahoo search
superpages.com
Thank you for taking the time to provide the information necessary to give an
accurate price of service.  You will be contacted within 2 business days.  If you
would like faster service please call the office directly.  
The information provided in this form will be held in the strictest confidence.  
We do not share information with anyone!  
All services are subject to availability.  Services must be scheduled by telephone
contact only.  We reserve that right to deny service for any reason.
CALL THE OFFICE FOR A FREE ESTIMATE!
(919) 872-9679
HomeAide Services, Inc.
Professional Housecleaning