First Name:

Last Name:

Phone Number:

Email Address:

Street Address:

City/State/Zip:

How did you hear about the Coop?

My residence is a:

Yes, we clean offices and commercial properties too! Call us 718-633-4823 for details.

Number of floors/stories:

Number of bedrooms:

Number of bathrooms (full and half):

Other rooms (check all that apply):

Kitchen

Living Room

Dining room

Office

Playroom

Den

Hallway

Foyer

Basement

Other (please list):

Additional services (check all that apply):

Clean Inside Oven

Clean Inside refrigerator

Clean interior window panes

Laundry

Ironing

Organize closets/cabinets

Do you have pets?

No      Dog       Cat      Other:

Please specify two or more dates that would be convenient for us to do your cleaning: