| Name: |
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| E-mail: |
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| Address: |
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| City: |
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| State: |
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| Zip: |
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| Day Phone: |
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| Work Phone: |
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| Time Table For Cleaning: |
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1
to 2 weeks 3 to 4 weeks 5
weeks or more
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| Carpet Cleaning: |
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Regular
Steam Fast Dry
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Please enter the approximate square
footage of each room |
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| Family Room Sq.Ft.: |
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| Living Room Sq.Ft.: |
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| Dining Room Sq.Ft.: |
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| Master Bedroom Sq. Ft.: |
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| Bedroom 1 Sq.Ft.: |
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| Bedroom 2 Sq.Ft.: |
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| Bedroom 3 Sq.Ft.: |
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| Bedroom 4 Sq.Ft.: |
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| Bedroom 5 Sq.Ft.: |
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| Hall Sq. Ft.: |
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| Stairs (Number of steps): |
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| Room 1: |
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| Room 2: |
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| Room 3: |
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| Stain Removal Please give: |
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| Stain: |
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Furniture Cleaning |
| Please provide details of furniture
to be cleaned. (eg. Color, Fabric) |
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| How did you hear about Beckett's?: |
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Mamma
Google Lycos
Other
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| For "Other" please explain here: |
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| Actual charges will be based on our final
measurements once in your home. Therefore the only reason why any pricing will
change will because you wanted something else done or the final measurements
were different than what was sent to us! |