Grace & Shine Cleaning Application

GRACE & SHINE CLEANING APPLICATION

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A Grace & Shine Cleaning can be for you or someone you know.

A Grace & Shine Cleaning is for anyone who really needs a cleaning but can not afford it.

Who is completing this application?

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number *

Email Address *

Who are you nominating for a Grace & Shine Cleaning?

Nominee Name *

First

Last

Nominee Address *

Address Line 1

Address Line 2

City

State

Zip Code

Nominee Phone Number *

Nominee Email Address *

Type of Assistance Needed:

Briefly describe your situation and why you or someone you know is in need of a Grace & Shine Cleaning *

Household Details:

Number of People Living in the Household *

Number of Bedrooms *

Number of Bathrooms *

Additional rooms or areas requiring cleaning:

Preferred Schedule:

Are there specific dates or times that would be most convenient for the cleaning service?

Additional Information:

Are there any specific cleaning tasks or areas of focus you would like us to prioritize?

Is there anything else you would like us to know about your household or situation?

Do you have pets? *

By submitting this application, I certify that the information provided is true and accurate to the best of my knowledge. I understand that completion of this form does not guarantee acceptance into the charity cleaning program, and that the decision is at the discretion of the cleaning business.

Type Signature *

Date *

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