Download our Cleaning Assesment Forms in ADOBE PDF format.

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The purpose of this questionnaire is to collect general information about your specific cleaning needs. This will enable our Application Specialists to correctly assess your problem and offer you a cost effective practical solution for your consideration.Our pledge is to properly serve your needs.
Company Name:
Contact Name:
Title:
Address:
Phone:
Fax:
Email:
Where or How did you hear about us?
 What is the nature of your company's business?


Approximate Square Footage of Area to be Cleaned    

Type of equipment currently used or have tried
Currently Use:
Previously Tried:
What areas are you most concerned about cleaning?
Floor
 Type of Floor:
Aisleways
 Aisle Width:
Overhead Areas
 Overhead Height:
Under Machinery
 How Accessible are the areas?
What type of debris do you need to collect?
Please note physical properties of debris:(choose as many as apply)
Dry |Type of Debris: Debris Size:
Wet
 Very Fine
Hazardous
 Temperature of Debris or equipment to be cleaned.
Lightweight
Heavy
 -----------Room Temperature
-----------Other
Other Characteristics:(Please List):
If you collected the debris for 1 day, how much would you accumulate?
Less Than 5 Gallons
About a 5 Gallon Bucket Full
More Than 5 Gallons, But Less Than 55 Gallons
About A 55 Gallon Drum Full
More Than 55 Gallons
How often do you normally clean the area or remove the debris?
Daily Weekly Monthly Annually
Other:

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