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Business Name

Contact Name

Approximate Square Footage

Number of Rooms

Is there a kitchen or lunch room?

Number of Restrooms

Do You Require Restrooms, Common Areas or Kitchens Restocked with Supplies?

Approximate Number of Desks / Workstations

Is There Any Medicial Equipment with Specific Cleaning Instructions?

What Type of Cleaning Frequency Do You Want?

Do You Have a Vacuum Cleaner & Supplies On-Site?

Comments / Instructions for the Cleaners

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