This registration is for Cleaning Services to be Added to our Preferred List.

If you are already registered click on LOGIN and enter your Username/Password

 

Cleaning Service Information

   
First Name: (Req)
Last Name: (Req)
   
If You Have A Business Name Enter it Here
If You Are a Business, # Of Employees

Website URL:
   
Cell Number: (Req)
Cell Provider: (Req)

Cell Provider Other: (Req if Provider is Other)
   
Office Phone Number:
Email Address(Req)
   
If You Have a Business Address....
 
Street Address:
Apt/Suite #:
City:
State:

Zipcode:

   
Put a Check Next to the Area You Service
 
   Navarre Beach
   Fort Walton Beach
 
Please Provide Your Minimum and Maximum Charges....
Minimum/Maximum Charge to Clean 1 Bedroom, 1 Bath: (Req)
From
To
Minimum/Maximum Charge to Clean 2 Bedroom, 2 Bath: (Req)
From
To
Minimum/Maximum Charge to Clean 3 Bedroom, 3 Bath: (Req)
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To
Do You Do Onsite Laundry? (Y,N): (Req)
If Y, Do You Charge Extra? if No Extra Charge Enter 0
Do You Do Offsite Laundry? (Y,N): (Req)
If Y, Do You Charge Extra? if No Extra Charge Enter 0
Do You Provide Trash Bags? (Y,N): (Req)
Do You Provide Clothes Washing Pods? (Y,N): (Req)
Do You Provide Dish Pods? (Y,N): (Req)
Do You Supply Toilet Paper? (Y,N): (Req)
Do You Supply Paper Towels? (Y,N): (Req)
Do You Supply Bath Hand soap? (Y,N): (Req)
Additional Information
How Did You Hear About Us?
   

Always a plus if you can provide references

Reference Contact
Name
Reference Email
Reference Cell #
Numbers Only
   
Login Information
 
Username:(Req)
Password (6+ char) (Req)
Confirm Password: (Req)
   

 

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