Ethical Floor Care by Chris: Professional Cleaning & Restoration: For My Clients

Client Profile Survey

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Last Name *

Female First Name

Male First Name

Occupation

Email *

Street Address *

City *

State *

Zip Code *

Home Phone *

Mobile Phone

Work Phone

Homeowner?

Yes No

Age of Home

Subdivision's Name

Is there an HOA?

Yes No

Do you receive an HOA Newsletter

Yes No

Are you a member of Angie's List?

Yes No

How Often would you like to have your carpets cleaned?

Does any one smoke in the home?

Yes No

Have Air Ducts ever been cleaned?

Yes No

If NO, do you have interest in having them cleaned?

Yes No

If YES, how long ago?

Does anyone have Allergy problmes?

Yes No

Do you have Pets?

Yes No

Dog

Cat

Please check ALL that appply to your home's Flooring

Carpet

Tile

Wood

Marble

Brick

Concrete

Oriental Rugs

Other

Please check ALL that appply to your home's Upholstery

Cotton

Synthetic

Microfiber

Leather

Not sure

Please share with us any concerns or thoughts you might have when it comes to your home's flooring and upholstery surfaces.

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