Request for Service / Estimate Please aloud at least 48 hours ==> Click here for copy of our Agreement for Services Phone: 704-502-2041 Fax: 704-298-4652 American Maids of NC, LLC This Submission form was provided to us free by Response-O-Matic. Please provide us with correct information, so we may supply you with an accurate estimate or to help you with your request. Contact Name: (First and Last) Company Name / Organization Email Address: Valid telephone number for contact: Address: (Number, Street, Drive, etc.) Location - city, state, & county: Charlotte, NC - Mecklenburg China Grove, NC - Rowan Concord, NC - Cabarrus Cornelius, NC - Mecklenburg Davidson, NC - Cabarrus Davidson, NC - Mecklenburg Davidson, NC - Rowan Enochville, NC - Rowan Harrisburg, NC - Cabarrus Harrisburg, NC - Mecklenburg Huntersville, NC - Mecklenburg Kannapolis, NC - Cabarrus Kannapolis, NC - Rowan Ladis, NC - Rowan Lake Norman, NC - Lincoln Lake Norman, NC - Mecklenburg Matthews, NC - Mecklenburg Midland, NC - Cabarrus Midland, NC - Stanley Mint Hill, NC - Mecklenburg Mint Hill, NC - Union Mooresville, NC - Iredell Mooresville, NC - Rowan Mt. Mourne, NC - Iredell Pineville, NC - Mecklenburg Rockwell, NC - Rowan Salisbury, NC - Rowan Other Zip Code: Requesting Stage: Planning & Budgeting Ready to hire Less than one week More than two weeks More than a Month Less than three months More than three months Establishment Type: Residential Rental Properties - Residential Rental Properties - Commercial Commercial Building Office Space Property Management Industrial Building Warehouse Retail Store Medical Facilities Restaurant Sports Bars / Pubs Athletic Facilities Educational Facilities Care Facilities - Child / Adult Churches Religous Facilities Nascar Racing Facilities Government Agency New Construction Post Construction Other: (List in comments) Total heated square footage: (Required) 0-999 sq.ft. 1000-1299 sq.ft. 1300-1599 sq.ft. 1600-1899 sq.ft. 1900-2199 sq.ft. 2200-2499 sq.ft. 2500-2799 sq.ft. 2800-3099 sq.ft. 3100-3399 sq.ft. 3400-3699 sq.ft. 3700-3999 sq.ft. 4000-4999 sq.ft. 5000-5999 sq.ft. 6000-6999 sq.ft. 7000-7999 sq.ft. 8000-8999 sq.ft. 9000-9999 sq.ft. 10,000-19,999 sq.ft. 20,000-29,999 sq.ft. 30,000-39,999 sq.ft. 40,000-49,999 sq.ft. 50,000-59,999 sq.ft. 60,000-69,999 sq.ft. 70,000-79,999 sq.ft. 80,000-89,999 sq.ft. 90,000-99,999 sq.ft. 100,000-149,999 sq.ft. 150,000+ sq.ft. Type of service requesting: House Cleaning Service Organizational Service Office Cleaning Service Maid & Butler Service Janitorial Service New Construction Cleaning Service Post Construction Cleaning Service Carpet & Floor Care Cleaning Service Window Cleaning Service Pressure Washing Service Swimming Pool & Spa Cleaning Service General Maintenance Care Recurring Service Requested: Daily (Mon-Fri) Nightly (Mon-Fri) Weekend1-Daily (Saturday) Weekend1-Nightly (Saturday) Weekend2-Daily (Sunday) Weekend2-Nightly (Sunday) Once a Week (Weekly) Twice a Week (Weekly2) Once every other week (Biweekly) Twice every other week (Biweekly2) Once a month (Monthly) Twice a month(Monthly2) One-Time Clean Spring Clean (Once a Year) Special Clean (Parties, Holidays, etc.) Other - Not listed (List in comments) Total levels/floors to be cleaned: (Example: 2.5 = 1 Main level, 1 Basement, .5 Loaf/Room) 1.0 Levels 1.5 Levels 2.0 Levels 2.5 Levels 3.0 Levels 3.5 Levels 4.0 Levels 4.5 Levels 5.0 Levels 5.5 Levels 6.0 Levels 6.5 Levels 7.0 Levels 7.5 Levels 8.0 Levels 8.5 Levels 9.0 Levels 9.5 Levels 10+ Levels List all floors and hard surfaces: Click all that applies. Carpet Hardwood Stone Vinyl Tile Laminate Marble Granite Limestone Cork Glass Slate Ceramic Pergo Plywood Concrete Rubber Steel Other Total number of bedrooms, offices, or classrooms: (Do not include bathrooms) 1 2 3 4 5 6 7 8 9 10 11 or larger Number of Full Bathrooms and Half Bath:(Example: 1.5 = 1 full 1 half) 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5 8 8.5 9 9.5 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 Over 30+ Click additional rooms that applies to your location. That was not added above. Kitchen Laundry Breakfast Nook Sun Room Family Room Living Room Dining Room Great Room Formal Dining Room Study Foyer Bar Area Theater Room Bowling Room Play Room Bonus Room Conference Room Break Room Lounge Mail Room Copier Room Receptionist Lab Clean Room Warehouse Receiving/Shipping Production Room Other Residential Room Other Commercial Room Other Industrial Room Additional services requesting: Change Linens Laundry Service Flipping Mattress Stove Cleaning Refrigerator - Wipe out Refrigerator - Full Clean Dishwasher Washer Dryer Ceiling Fans Light Fixtures Moving Furniture Window Screens Blinds Handyman Plumbing Electrical Other No Additional Request How many people living or working at location? Do you have pets and or kids under 18: YES (PET'S ONLY) YES (KID'S ONLY) YES (PETS & KIDS) NO (PET'S OR KIDS) YES; to kids then answer age groups: Newborn to 1 month 1 to 12 months 13 to 18 months 19 to 24 months 2 to 5 years 6 to 12 years 13 to 17 years No Kids Yes; to pets then answer what type of hair lenght: Hairless Short Medium Long No Pets How did you hear about us? Newspaper Yellowpages Whitepages Insiderpages Yahoo Google Gowalla Facebook Foursquare LinkedIn MySpace MerchantCircle Ask Bing Citysearch Twitter Yelp YouTube Sign Business Card Referred by AMNC Client Referred by a friend Other: (List in comment area) Are you interested in our mailing list? This list are used for special offers, discounts, coupons, and or holiday cards for future customers of AMNC, LLC(Emailed only): YES NO MAYBE NOT AT THIS TIME Are you interested in our referral programs? Learn how to receive your free clean today: YES NO MAYBE NOT AT THIS TIME Customer Comment: List anything that you think is important but not mention above. Thank you for giving us the chance to show you what sets us apart from other cleaning companies in this industry. Someone will contact you shortly, but if a call fails to go out within 24 hours, please call us at 704-502-2041. When you click submit form, on next page don’t forget to send form, then a confirmation will confirm that the information was sent. Thank you Get your own free form like this one.