Date: ________________

Start Date: ________________

Cleaning Estimate
Name: _________________________________ Referred By: ____________________________

Phone: _________________________________

Address: ________________________________

Cleaning Schedule

One-Time  Weekly  Bi-Weekly  Monthly 

Day Preference Time of Day

M  T  W  TH  F  __________am _________pm

Cleaning Details

Standard Clean (everytime)

¨ Kitchen ¨ Bedroom 1 ¨ Stairs

¨ Bathroom ¨ Bedroom 2 ¨ Laundry Room
¨ Bathroom 2 ¨ Bedroom 3 ¨ Other
¨ Bathroom 3 ¨ Office ¨ Other

Cleaning supplies provided? Yes  No  $25 first clean, $5 each cleaning after that.

Extra Rooms: ________________________________________________________________

Notes: _____________________________________________________________________

____________________________________________________________________________

Extra Services

Deep Cleaning Needed? Yes  No  If so, what: Cabinet doors  Blinds  Baseboards 

Excessive Mildew  China Cabinets  Doors/Door frames  Face Plates 

Errand Service? Yes  No 

Organization? Yes  No 

Estimate

Rate $___________ Estimated Time _________________

Discount $___________
Extra Charges $___________
Total $___________