Quality Post Card

What is your name?

What is your email address?

What is your daytime phone number?

( ) -

Do you want for us to phone you?

Yes No

What was the date of cleaning?

	Excellent	Satisfied	Needs Improvement	Name of Cleaner (if known)
Kitchen
Bathrooms
Dusting & Cobwebs
Vacuuming
Master Bedroom
Baseboards
Ceiling Fans (That can be safely reached)
Overall Impression

Optional Additional Comments:

* Indicates a required field.

Just makin' sure you're human:

Please type (in the box above)
the squiggly text you see right up there

Proudly serving Clark County.