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First name
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Last name
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Mobile phone number
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Email
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What Service(s) Are You Interested In?
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Green Cleaning
GlowClean Rotation
Decluttering & Organization
Move-In Assistance
What Is Your Preferred Frequency for Cleaning Services?
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Please Select
One-Time Service
Weekly
Bi-Weekly
Monthly
Is This Service for Your Home or Someone Else's?
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Please Select
My Home
Someone Else’s (e.g., a family member)
What Is the Primary Goal of These Services?
Example: “Help with downsizing,” “Keep my home consistently clean,” etc.
Do You Have Any Special Requests or Needs?
Street address
City
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What Days Work Best for You?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Preferred Time of Day
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Morning
Afternoon
Evening
How Can We Best Reach You?
Phone Call
Email
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