COMMERCIAL CLEANING CONSULTATION & FACILITY INTAKE FORM

COMMERCIAL CLEANING CONSULTATION & FACILITY INTAKE FORM

COMPANY & CONTACT INFORMATION

Company/Organization Name:

Primary Contact:

Job Title/Role:

Phone:

Email

Address

Billing Address, if different:

Preferred Contact Method:

Number of Floors:

Short answer

Approximate Number of Employees/Regular Occupants:

Approximate Daily Visitors/Customers/Patients:

Number of Offices:

Number of Restrooms:

Number of Breakrooms/Kitchens:

Other significant rooms/areas:

. FLOORING & SURFACES

Are there areas requiring special floor care?

Yes

No

Unsure

If yes, describe:

Short answer

Does the facility contain specialty, delicate, or restricted surfaces

Yes

No

Unsure

f yes, describe:

Preferred Cleaning Days:

Desired Start Date:

Is the facility currently being professionally cleaned?

Yes

No

Who currently performs the cleaning?

Cleaning Company

Individual Cleaner

In-House Employee/Custodi

Other

Why are you considering a change or additional service?

What are the biggest cleaning concerns at the facility?

Are there recurring complaints or problem areas?

Yes

No

If yes, explain:

Who provides consumable restroom supplies such as toilet tissue, paper towels, soap, and liners?

Client

Cleaning Company

Would Like Pricing/Options

Is an onsite walkthrough available?

Yes

No

Preferred Walkthrough Date/Time: