Client Intake
Form

Name *

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Do you require a laundry service added to your clean? *

Yes

No

Do you have pets? *

No

Yes

When would you like to book?

Select your ideal date

MM

DD

YYYY

Signature checklist *

I have reviewed Terra Scrub’s Signature Checklist (included in your welcome email)

Policies and Procedures *

https://terrascrubcleaning.com/faq/

I have reviewed Terra Scrub’s Policies and Procedures provided in the link above