Schedule An Appointment Schedule a Job or Consultation First Name*Last Name*Have you used Pristine Clean before?*YesNoWhat do you desire to book?*ConsultationCleaningType of establishment*ResidentialCommercialAddress* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home PhoneCell PhoneWork PhoneExt.Email I prefer to be contacted by*Home PhoneCell PhoneWork PhoneIf We Should Have Any Questions About Your ProjectDo we have your permission to call you at work?*YesNoIf necessary, how late in the evening would you accept our call?*The following questions help us understand the approximate time your job will require.How many stories is your home?1 story2 story3 story4 storyYour entire home is approximately how many total sq. ft?Do you currently have pets?YesNoDo you currently have children?YesNoDid Pristine Clean clean your carpets the last time they were cleaned?YesNoWhen was the last time you hired someone to clean your carpets/upholstery?Not Sure6 months - year2 years3-4 years5+ yearsNeverThe Type of Cleaning You Desire: Carpets Upholstery Protectant Rugs Natural Stone Hardwood Tile & Grout Other What other service(s)?The Room(s) That You Want Cleaned Bedroom #1 (Master) Bedroom #2 Bedroom #3 Bedroom #4 Bedroom #5 Guest Bedroom Living Room Family Room Dining Room Office Study Den Kitchen Bonus Room Bonus Room Stairs Front Stairs Back Stairs Additional Stairs Loft Media Center Sun Room Workout Room Hallway (Upstairs) Hallway (Main) Additional Hallway Additional Hallway Other Room(s)Areas of concern requiring special attention:If you have any special areas of concern, such as pet odors, stains or food/drink stains that will require additional attention, please let us know here.SofaPlease enter a number from 1 to 3.ReclinerPlease enter a number from 1 to 3.Dining Room ChairPlease enter a number from 1 to 12.ChaisePlease enter a number from 1 to 3.Love SeatPlease enter a number from 1 to 3.ChairPlease enter a number from 1 to 5.Over-stuffed ChairPlease enter a number from 1 to 3.Sectional Sofa (# of seat cushions)Please enter a number from 1 to 8.Wingback ChairPlease enter a number from 1 to 5.OttomanPlease enter a number from 1 to 3.Do you have any stains or areas of concern on your furniture other than normal soiling? If so, please indicate which piece and the nature of your concern.Request your appointment date and time:1st Choice Date Format: MM slash DD slash YYYY Time : HH MM AM PM 2nd Choice Date Format: MM slash DD slash YYYY Time : HH MM AM PM 3rd Choice Date Format: MM slash DD slash YYYY Time : HH MM AM PM Or simply select these appointment options:Please contact and inform me what available options I have for this week:Please contact and inform me what available options I have for next week:Please contact and inform me what available options I have for next month:How were you referred to Pristine Clean?Personal FriendNeighborFamilySearch Engine - GoogleSearch Engine - YahooSearch Engine - OtherRealtorCarpet StoreRadio AdMagazine AdPristine Clean VanOtherIf OtherName of person that referred youCommentsThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.
