Contact Name *

First Name

Last Name

Contact Phone Number *

(###)

###

####

Building Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Are there floor plans available? *

Yes

No

Is there public access to washrooms? *

Yes

No

What is your request for cleaning frequency per week? *

7 days/week

5 days/week

3 days/week

2 days/week

1 day/week

What time of day would you like our services to operate? *

Daytime

Evening

Both

Either

Are paper products and handsoap included? *

Included

Supplied by Scollard

Not Applicable

Are you interested in a member of our Scollard team doing a site visit? *

Yes

No

Name *

First Name

Last Name

Phone *

(###)

###

####

I would prefer to be contacted via

Phone - Daytime

Phone - Evening

Email