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Request for Estimate or Services
Thank you for your interest in our services. As of 3/1/17 Quality Cleaning Maid to Order is no longer taking on any new clients under that name or business model. Effective 4/15/17 we formed Home Care Referral Agency ( https://www.hmcarereferral.com/ ) and now act as a placement Agency that will completely vet and match independent professionals of all types who work in or around the home with home owners needing their services, while we at the Agency provide top level customer service and support by handling your scheduling, billing/payments, work order notes and accounts professionally. By providing the information below we can assist you in providing you with the closest possible estimated quote possible without having to come in and personally seeing your home. We at Home Care Referral Agency respect your privacy and do not believe in high pressure sales. If you check the box at the bottom of this form that you wish to be contacted this once only we will delete all your information after 3 months and you will need to provide it again if you want services/ quotes after that time span.
I need info/ to hire*
Information only please - I`m still shopping around
Ready to hire - schedule ASAP contingent on acceptance of price
First Name:*
Last Name:*
E-Mail address:*
Home Phone:*
Cell Phone:*
Preferred method of contact*
Type of dwelling*
Single family home - 1 story
Single family home - 2 or more stories
Address Line 1: No PO box #s*
Address Line 2:
Zip Code:*
# of persons residing in home (total count)*
# of persons under the age of 18*
# of cats, dogs or birds in the home*
Type of services needed*
One time move in/ out or prep for sale type of cleaning
One time deep/ spring clean
One time only lighter cleaning
Once a month services - whole home
Every other week (bi/wkly) - whole home
Every week - whole home
Kitchen and bath(s) only special
Partial home only (please add notes in the comment section)
Rotation of whole & partials (please add notes in comment section)
Windows and screen cleaning
Other services
I`m not completely sure yet (please add notes in comment section)
desired frequency of services *
One time only
Once a week
Every other week - bi/wkly
Once a month - every 4 weeks
I`d like to just call in whenever I need additional help
I`m not completely sure yet (please add notes in comment section)
preferred days to be cleaned*
Monday (am - 9 -12 noon)
Monday (pm - 12 noon - 4pm)
Tuesday (am - 9 -12 noon)
Tuesday (pm - 12 noon - 4pm)
Wednesday (am - 9 -12 noon)
Wednesday (pm - 12 noon - 4pm)
Thursday (am - 9 -12 noon)
Thursday (pm - 12 noon - 4pm)
Friday (am - 9 -12 noon)
Friday (pm - 12 noon - 4pm)
Saturday (We do not guarantee to be available every Saturday)
I`m not completely sure yet
Requested start date*
Approx size of home *
500 sq ft - 1000 sq ft
1001 sq ft - 1500 sq ft
1501 sq ft - 2000 sq ft
2001 sq ft - 2500 sq ft
2501 sq ft - 3000 sq ft
3001 sq ft - 3500 sq ft
3501 sq ft - 4000 sq ft
4001 sq ft - 4500 sq ft
4501 sq ft - 5000 or more sq ft
Parking situation or possible obstructions*
Parking avail in front or back of home (very close access)
Guest parking only avail (short haul from home)
Parking is very limited (long haul may be required)
2nd or higher story apt/ condo with no elevator
Gated community that requires gate access codes
Vendor parking passes required for parking
Access only granted by onsite property management office
# of bedrooms and baths *
1 bedroom/ 1 bath
1 bedroom / 1.5 baths
2 bedroom / 1 bath
2 bedroom / 2 baths
2 bedroom / 2.5 baths
3 bedroom / 1 bath
3 bedroom / 1.5 baths
3 bedroom / 2 baths
3 bedroom / 2.5 baths
4 bedroom / 2 baths
4 bedroom / 2.5 baths
4 bedroom / 3 baths
5 bedroom / 3 baths
5 bedroom / 3.5 baths
Other - please note in comments section
Extra services required
Windows washing
Oven cleaning
Refrigerator cleaning
Wall washing (not referring to shower walls)
Steam cleaning floors
Power scrubbing floors
Carpet cleaning
Other - please note in comments section
Clutter levels*
Empty home / no furnishings
Little to no clutter
Average clutter
Slightly more than normal clutter
Very cluttered
Soil levels*
Little to no soil/ build up
A slight amount of soil/ build up
Average soil/ build up
Slightly more than normal soil/ build up
Very soiled / lots of build up
Last time home was thoroughly cleaned*
We clean regularly but we have better things to do - within 30 days
We clean occasionally -within the last 60 days
We clean only when we absolutely need to - its been 2 to 6 months
Please don`t judge me please if I say never - its been over 6 months
We try to answer all requests for information received during our normal working hours within a 4 hours of receipt. Requests received after hours or on days that we are closed may not be answered until our next business day.

Upon receipt of your request a representative from Home Care Referral Agency will contact you and provide to you the information / quote that you are requesting. Please be advised that all quotes are based upon assumptions that homes are in average condition per your descriptions . Extreme soil, build up and clutter will assuredly increase pricing. If we find upon entering the home that the conditions do not match what we based our quote on we will contact you first before starting work to discuss any pricing changes or prioritizing your needs so that we can fit your budget

Scheduling is based upon availability. We try our best to fill your requests but popular days and times fill up quickly and may not be available.

Questions or comments
How did you hear about us?*
Newspaper ad
Phone book
Search Engine
Direct Mail
Door hanger
Angie`s List
Can we hold on to your info *
Yes, I would like to be contacted again if you run any Sales
No, I`d prefer that you not contact me beyond this one request
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