Name *

First Name

Last Name

Phone *

(###)

###

####

I’m interested in help with ... *

Housekeeping

Janitorial Services

Custodial Services

Errands

Groceries

Recommendation

Complaint

Other

If custodial/janitorial services please indicate square feet of building, times per week or month, amount of bathrooms, number of floors, etc.

less 2500 sq. ft.

more than 2,500 sq ft less than 5,000 sq ft.

more than 5,000 sq. ft. less than 10,000 sq. ft.

more than 10, 000 sq. ft.

more than 20,000 sq. ft.

first floor

two-four floors

five floors or more

two bathrooms

four - six bathrooms

more than 10 bathrooms

daily

once a week

twice a week

3-5 days a week

once biweekly

twice biweekly

once monthly