Natural Housekeeping, Inc.
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Natural Housekeeping Request Form
About You
Name
Address
Apartment/Unit
City
State
Zip/Postal Code
Telephone
E-mail
Home Profile
Home Type
(select one)
Apartment
Studio
Condominium
Townhouse
Brownstone
Single-Family Home
Multiple Family Home
Duplex
Office
Square Footage
Appliances
Stainless Steel
Black
White
Floor Type
Hardwood
Carpeting
Ceramic Tiles
Linoleum
Marble
Stone
Vinyl
Countertop
Granite
Engineered Stone
Solid Surface
Laminate
Wood or Butcher Block
Stainless Steel
Ceramic Tile
Pets
Yes
No
Breed
Green Service
Frequency of Service
(select one)
Try-out
Weekly
Bi-weekly
Every three weeks
Monthly
Quarterly
Bi-Annual
Annual
Type of Service
*
Green Standard
Green Special
Green Moving
Green Annual
Green Carpet/Upholstery
Green Standard include
Wash Dishes
Change Bath Linens
Change Bed Linens
Green Special Service/Comments
indicate service
Date Service Needed
1
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January
February
March
April
May
June
July
August
September
October
November
December
2010
2011
How did you hear about us
(select one)
bing
friend
hoboken.com
hoboken411.com
hobokeni.com
hobokenx.com
kannekt
google.com
manta
other
other search engine
web promotion
yahoo.com
Promo Code
Servicing Hoboken, Jersey City,
Weehawken, Edgewater, West New York, Guttenberg, Fort Lee, and Secaucus
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