Survey Form Name: Address: City: Zip Code: Date of Service: Are you a regular or first time customer? Regular Customer First Time Customer If you are a regular customer, what schedule are you on? Monthly Quarterly Semi If you are a new customer, how did you hear about us? Select One.... Family Friend Advertisement Flyer Internet Website Phonebook Other Were we able to schedule you in a timely manner? Select One.... Yes No Were we given a week's notice of your desired time? Select One.... Yes No Did our staff arrive on time? Select One.... Yes No If not, did they call you with an explanation and a new estimated time? Select One.... Yes No Was the staff polite, courteous, and professional? Select One.... Yes No Average Above Average Were you happy with the quality of your cleaning? Select One.... Yes No Average Above Average Would you recommend us to family and friends? Select One.... Yes No Please rate your overall satisfaction from 1 to 5 (5 being the best). 1 2 3 4 5 Please add any additional comments in the space provided: Would you like us to contact you to address any concerns? Select One.... Yes No Phone Number: Best time to be reached: Morning Noon Afternoon Evening Do we have permission to quote you on any praises? Select One.... Yes No May we list you as a reference this means you may be contacted by a prospective customer? Select One.... Yes No

Note: Your number will not be listed on our website and we will give out a list of references only by request to protect your privacy