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Property Address (required) Suite or APT # (required)
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Home Phone#
Work Phone# Cell Phone#

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I would like too: (required)
---Schedule an appointmentInquire about AvailabilityRequest Info before schedulingInquire about specific pricing

Requested service date:
First available dateDon't schedule me yetNeed a specific date *(specify below)

Please confirm via:
E-mailPhoneBoth

Please Tell Us about Your Home:

Number of Bedrooms:
---01020304050607080910

Number of Bathrooms:
---01020304050607080910

Number of Levels:
---01020304

Do you have any Pets?
YesNo

Type of Pets:

Please check the type of service requested:
Basic cleaning onlyBasic cleaning with optional services

Please specify desired optional services:
Oven Cleaning: $20.00Refrigerator Cleaning: $20.00Hand Polish Furniture: $9.50 each pieceVacuum Furniture: 10.00 each pieceFireplace Cleaning: $20.00Window Cleaning: $4.50 ea. (inside only)

Payment Information:

Type of Payment:
CashCheckCredit CardOther

We Guarantee our cleaning 100%. If you are not satisfied with our services, call us within 24 hours, otherwise, we will understand that all services have met your expectation and we will not consider your complain. All new services are to be paid in full prior to the date of service.

We request that all customers give 24 hour notice for all cancellations. Cancellations without this advance notice will be subject to a $25.00 surcharge. If we arrive at the home and you cancel once we have made the trip out there, we reserve the right to charge a $50.00 trip fee.

After the first cleaning, customer will provide all supplies. In case VIA Maid Services® has to provide the supplies, a charge of $ 5.00 extra will be add to your cleaning fee.

I have read FAQ, Services and understand the terms and conditions of your pricing and agree to pay accordingly for services rendered.

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