Your Name * Cleaning Service Proviced Date Cleaned Your Telephone * Your Address Appearance* ------ Excellent Good Average Poor Unsatisfactory Courtesy* ------ Excellent Good Average Poor Unsatisfactory Professionalism* ------ Excellent Good Average Poor Unsatisfactory Teamwork* ------ Excellent Good Average Poor Unsatisfactory Cleaning Quality (Living Area)* ------ Excellent Good Average Poor Unsatisfactory Not Applicable Cleaning Quality (Kitchen)* ------ Excellent Good Average Poor Unsatisfactory Not Applicable Cleaning Quality (Bathrooms)* ------ Excellent Good Average Poor Unsatisfactory Not Applicable Cleaning Quality (Floors)* ------ Excellent Good Average Poor Unsatisfactory Not Applicable Feedback or Message *

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