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First Name
Street Address
City
Province
Postal Code
Email Address
Contact Phone Number
How do you wish to be contacted?	Email Phone
Condition of Furniture	Good Fair Poor
Condition of Carpet	Good Fair Poor
Estimated Age of Carpet/Upholstery	1-5 Years 6-10 Years 11-15 Years 15 Years + Not Sure
Areas to be cleaned (please select all to be cleaned)
Living Room	1 2 3 4 5 More
Dining Room	1 2 3 4 5 More
Hallway	1 2 3 4 5 More
Family Room	1 2 3 4 5 More
Den	1 2 3 4 5 More
Stairs	1 2 3 4 5 More
Kitchen	1 2 3 4 5 More
Bedroom	1 2 3 4 5 More
Bathroom	1 2 3 4 5 More
Rec Room	1 2 3 4 5 More
Area Rug (wool)	1 2 3 4 5 More
Area Rug (synthetic)	1 2 3 4 5 More
Upholstery to be cleaned (please select all to be cleaned)
Sofa	1 2 3 4 5 More
Loveseat	1 2 3 4 5 More
Chair	1 2 3 4 5 More
3-Seat Sofa	1 2 3 4 5 More
5-Seat Sectional	1 2 3 4 5 More
Ottoman	1 2 3 4 5 More
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