Complete this form to receive an estimate cost for cleaning an empty residential dwelling.
Please refer to the Move-In/Move-Out Checklist for what this service includes.
Water and electricity must be available at the service address.
All Move-In/Move-Out Services must be in advance by Cash, Money Order or Credit Card.
Free Estimate For
Move-In or Move-out 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 or forwarding 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
Preferred
day
(SUBJECT TO
AVAILABILITY)
type of service
Hold the Control button to make  
multiple selections.
what date do you need service?
what is the size of the dwelling?
How many bedrooms?
How many bathrooms?
what percentage of home has
hardwood flooring?
Select Additional services (not included in move-in/move-out checklist)
Interior Refrigerator
 Interior Oven
Interior Microwave
Interior Windows
Carpet Cleaning
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.
YOU MAY ALSO CALL THE OFFICE FOR A FREE ESTIMATE!
Wake County (919) 872-9679
Chapel Hill/Durham (919) 929-2487
HomeAide Services, Inc.