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Have you used Fresh Start before?	Yes No
Is this a residential or commercial location?	Residential Commercial
If this is a commercial location or multi-unit building, please call our office at (770) 575-5758
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Address 1
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Subdivision or Community:
Nearest Cross-Streets:
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Email Address*
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Do we have your permission to call you during the day?		Yes No
When is the earliest we may contact you on a weekday?
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When is the latest we may contact you on a Saturday?
Internet Only Specials:
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Project Estimation Questions
Please provide as much information as possible; your answers to these questions help us determine the scope of the project and generate an accurate estimate.

How many stories are in your home?
Your entire home is approximately how many total sq. ft?
Do you currently have pets?	Yes No
Do you currently have children?	Yes No
Any children under the age of 5?	Yes No
What is your primary reason for cleaning (allergens, maintenance, visible soil, etc.)
Do you own a home-type carpet cleaner?	Yes No
When was the last time you hired someone to clean your carpets/upholstery?
Did Fresh Start clean your carpets the last time they were cleaned?	Yes No
If not, what is the company's name?

Which Services do you want Fresh Start to provide? Please click all that apply.

Carpets*:		Tile & Grout:
Upholstery:		Pet Odor Removal:
Carpet Restretching / Repair		Rugs / Oriental Carpet
Protectant:		Other:
*Please indicate your carpet color(s):

Check The Box Next To The Room(s) That You Want Cleaned:

Bedroom #1 (Master):		Bonus Room :
Bedroom #2:		Bonus Room Stairs:
Bedroom #3:		Front Stairs :
Bedroom #4:		Back Stairs :
Bedroom #5:		Additional Stairs :
Guest Bedroom:		Loft:
Living Room :		Media Center :
Family Room :		Sun Room:
Dining Room :		Workout Room :
Office:		Hallway (Upstairs):
Study:		Hallway (Main):
Den:		Additional Hallway:
Kitchen:		Additional Hallway :
Other:		Other:
Other:		Other:

Special Areas of Concern: If you have any areas that will require additional attention (food/drink stains, set in stains, etc.) please let us know that we can allot enough time to complete your project. For food or drink stains, provide the nature of the stain (wine, grape juice, etc.), color of the carpet, and age of the stain.



Pet Odor / Stain Removal Concerns: If you have pet odor concerns, please include as much of the following information as possible: Pet type (dog, cat, etc.) age, weight, breed, gender, any medications, stain source (if known), any attempts to remove stain/odor, age of stain.

Furniture Cleaning: Select the number of items to be cleaned.
Sofa:		Chair:
Recliner:		Over-stuffed Chair:
Dining Room Chair:		Sectional Sofa (# of seat cushions)
Chaise:		Wing-Back Chair:
Love Seat:		Ottoman:


Special Ares of Concern - Furniture: If you have any areas of concern on your carpet other than normal soil, please describe in as much detail as possible.

Appointment Date & Time:

1st Choice:	Time: AM PM
1st Choice:
2nd Choice:	Time: AM PM
2nd Choice:
3rd Choice:	Time: AM PM
3rd Choice:

Or simply select these appointment options:
Please contact and inform me what available options I have for this week:
Please contact and inform me what available options I have for next week:
Please contact and inform me what available options I have for next month:
We will contact you within one business hour.

How were you referred to Fresh Start?
If Other:
Name of person that referred you: