We accept:
Our Mission:
<Your Mission Statement Here>
We value your feedback! Please fill in the form below. Fields marked with an (
*
) must be filled in.
If you are not satisfied with the services rendered or need to address a concern, please notify our office within 24 hours of the service date.
*
E-mail Address:
*
Name on Account:
*
Date of Cleaning:
*
Daytime Phone:
Cleaning Specialist's Name (if known):
Kitchen Area
Dusting
Satisfied
Satisfied
Not Satisfied
Not Satisfied
Needs Improvement
Needs Improvement
Bathroom
Vaccum/Cobwebs
Satisfied
Satisfied
Not Satisfied
Not Satisfied
Needs Improvement
Needs Improvement
Questions or Comments:
© <Company Name> 2006
10 Street Name, City, NY 12345
Tel: (555) 123-4567
