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Contact Info
Name:
*
Company:
*
Address 1:
*
Address 2:
City:
*
State:
*
Zip:
*
Phone:
*
Fax:
Email:
*
Type of Company:
*
select...
Manufacturing
Office
Retail
School
Industrial
Employee Count:
*
select...
1-10 Employees
10-20 Employees
20-30 Employees
30-40 Employees
40-50 Employees
50+ Employees
Approximate Desk Count:
*
select...
1-5
6-10
11-15
16-20
21-25
25+
Frequency of Cleaning:
*
select...
2 days a week
3 days a week
4 days a week
5 days a week
6 days a week
7 days a week
Number of Restrooms
Men:
Stalls per Bathroom (Men):
Women:
Stalls per Bathroom (Women):
Preferred Cleaning Times:
select...
8am-10am
10am-2pm
2pm-5pm
After 5pm
Would you like us to supply cleaning products?:
select...
Yes
No
Would you like us to supply paper products?:
select...
Yes
No
Approximate Percentage of Floor Covering
Tile:
Terrazzo:
Carpet:
Marble:
Computer Flooring:
Aprox total square foot:
*
How many elevator cars are there?:
select...
1-2 Elevators
2-5 Elevators
6-9 Elevators
10+ Elevators
How many stair wells?:
select...
1-2 stair wells
3-5 stair wells
6-9 stair wells
10+ stair wells
How many cleaners currently clean your facility?:
select...
1
2
3
4
5
6
7
8
9
10+
How many hours each day /evening?:
select...
2
3
4
5
6
7
8
9
10+
How many Floors?:
select...
1
2
3
4
5
Areas to be cleaned:
Lobby
Reception Area
Hallways
Stairways
Private Offices
Elevators
Conference Rooms
Kitchen
Gym
Lounge
Cubicles
Fitting Rooms
Retail Showrooms
Sales Floors
Stock Room
Merchandise Displays
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