Gender
Female    Male

Date of Birth
Day Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year

Which package would you like?

Package one - Sweet Homemaker
Package two - Comfy Home
Spring Cleaning Service
 

When would you like us to visit your home?

Day Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year

Credit Card Number

Special Requirements/Comments:

By submitting this form, a deposit of $100 will be deducted from your bank account and it will be non-refundable. The balance of your package will then be charged after the service is rendered.