Lasting Image Bid/Proposal Request Form

Please fill out the following form
an we will contact you to set up an appointment.

Company Name:
Address:
Contact Name:
Phone Number:
Fax Number:
E-mail Address:

Total area square footage to be serviced:
Flooring, please provide footage for:		Restroom facilities, please provide total number:
Vinyl tile:		Commodes:
Linoleum tile:		Sinks:
Ceramic tile:		Urinals:
Concrete:
Carpet:

 

Cleaning Frequency Per Week:

1x 2x's 3x's 4x's 5x's 6x's 7x's

 

Buffing Frequency Per Month:

0x's 1x 2x's 3x's 4x's Other

Please select the services you want your customized proposal to include?

Cleaning Services	Facilities Services
Floor Strip and Refinish Janitorial Services Low Moisture Carpet Cleaning Steam Carpet Cleaning	Baseboard Cleaning & Replacement Door Repair General Office Remodeling Interior Painting Tile Replacement

If you have any special requests or additional information
that this form did not cover please include it in the field below.