Capital Cleaning and Building Services

Name *

HM Phone or Cell Phone or both. *

How did you hear about us? * 🛈

Are you interested in possibly having your home cleaned on a regular basis? * 🛈

What type of cleaning are you looking for? * 🛈

Do you own or manage any offices, rental or commercial properties that might need servicing? * 🛈

Are you interested in any add on services? * 🛈

	Yes	No
Inside Refrigerator $25.00	Yes	No
Inside Oven $25.00	Yes	No
Windows $3.00 Ea	Yes	No
Baseboards $19.95	Yes	No
Blinds $3.00 Ea	Yes	No
Light Fixtures and Ceiling Fans $10.00	Yes	No
VIP (appt within 72 hrs) $35.00	Yes	No
Weekend Service $35.00	Yes	No

Address, City, State, Zip *

If you purchased a coupon, how many did you buy and how many hours each?

Email Address *