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Customer Booking Information
First Name:	Last Name:
* *	* *
Phone Number:	Cell Number:	Alternate Phone Number
* *
Best Time to Reach You At:
Address:
* *
Major Area of City:
* *
Postal Code:	Email Address:	New or Repeat Customer?
* *		New     Repeat
Number of Hours and Pricing
Pricing:	1 Maid with no product supplies or equipment - $35/hour 2 Maids with all product supplies and equipment - $70/hour
	Repeat Customers = $66/hour
Number of Hours:	2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Date and Time of Cleaning
Choose Date:
* *
** Choose Arrival Timeslot:
Morning      Noon      Evening
Payment Info
Name on Card:	* *
Type of Card:	Visa Mastercard American Express * *
Credit Card Number:	* *
CSC Code:	* *
Exp. Date (mm/yy):	**
	* Fields Are Mandatory