Your Name:     Company Name:

Address:     City:     Zip:

Tel:     Fax:     Email:

Your Position:     Preferred Method of Contact: Please choose Schedule a visit E-mail Telephone Mail Fax

This is for a building: Please choose just being built currently with another janitorial company with an in-house cleaning staff

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Total Cleanable Square Footage:     % Carpeted     % Hard Flooring

Number of floors in your building:    Current monthly budget for cleaning:

Number of restrooms:     Number of kitchenettes:     Number of tenants:

Expected time of cleaning:     Number of nights we would clean weekly:

Please rate the cleanliness of your facility: Please choose 1- It's bad-the dust bunnies are holding us hostage. 2 3 4 5 - Average 6 7 8 9 10 - It's so clean we regularly eat off the floors.

Carpet cleaning:   Yes   No                            Hard floor restoration:   Yes   No

Biggest challenges you are now having: