If you require our services, we invite you to reach out to us directly via phone OR by filling out the Service Form and utilizing our self-booking system.
Please note that this form cannot be printed as a legal document. For any agreements or forms, please get in touch with Sparkly Housekeepers. Thank You.

Client Name of bounced check _________________________________________

 Employee Name ____________________________________________________ 

Date check bounced ______________________ 

Time Check bounced ________________________ 

Location Check bounced ______________________________

Did Client get Notified? Yes/No

Client approved charging card on file for service scheduled. Yes / No 

Is client aware the card on file will be charged for bounced check? Yes / No 

Did Client have any comments or concerns?  Yes/ No 

Clients concerns or comments......

  Amount Client is charged for bounced check $________.00 

Did client pay fee Yes / No

 Date paid ___________________ Time paid ____________________ 

employees signature _________________________________________________________________ 

Date _____________ Time ______________

If you require our services, we invite you to reach out to us directly via phone OR by filling out the Service Form and utilizing our self-booking system.
Please note that this form cannot be printed as a legal document. For any agreements or forms, please get in touch with Sparkly Housekeepers. Thank You.