Service Request Form

Please fill out as much information as possible. A representative will contact you to confirm your request.

( * indicates required field.)

Step 1: Contact Information

Name: *
Address: *
City: *
State: *
Zip: *
Phone Number: *
E-Mail Address: *
How did you hear about us? *
How would you like to be contacted? *	Phone Email
If by phone, when is the best time to call?
Coupon Code:

Step 2: Service Needed

Please fill in as much detail as possible for each requested service.

	Area Rug/Oriental Rug Cleaning
	No. of Rugs:
	Rug Size:
	Do your rugs have fringe?	Yes No

	Drop-Off or Pick-Up:
	I will drop off the rugs. Please provide an estimate.
	I want Aladdin to pick up my rugs. ( See Schedule )
	Special Concerns:

	Carpet Cleaning
	No. of Rooms under 12'x15':
	No. of Rooms larger than 12'x15':
	No. of Bathrooms, Hallways and Walk-in Closets:
	No. of steps:
	Reason For Cleaning:

	Areas of Special Concern:

	Upholstery/Furniture Cleaning
	Describe the furniture you want cleaned and the number of pieces: (i.e. 1 sofa, 2 upholstered chairs, 6 dining room chairs, etc.)

	Is any of the furniture white?	Yes No
	Areas of special concern:


	Hard Surface Cleaning
	Type of surface:
	Approx. size of space to clean (i.e. 10'x12'):
	Areas of special concern:

	Air Duct Cleaning
	No. of registers (incl. return):
	No. of A/C units:
	Areas of special concern:

	Drapery Cleaning
	No. of Drapes:
	Describe the drapes to be cleaned, including the approximate length and number of pleats on each:

Step 3: Request an Estimate/Schedule Service

Please select from the following: *

	I would only like an estimate at this time
	(Skip the next section and click submit)

	Please schedule me for the following date and time:
	(Please allow us at least one business day to process your request)

Special Requests:

For security purposes, please enter the characters you see in the box below. Please make sure the letters match what is in the box. The letters ARE case sensitive.

Please review your information and press "SUBMIT". Our team will contact you with an estimate and to verify your requested service time.

Service Scheduling and 24 Hour Emergency

Service Request Form

Step 1: Contact Information

Step 2: Service Needed

Area Rug/Oriental Rug Cleaning

Carpet Cleaning

Upholstery/Furniture Cleaning

Hard Surface Cleaning

Air Duct Cleaning

Drapery Cleaning

Step 3: Request an Estimate/Schedule Service

Service Scheduling and
24 Hour Emergency