Special Request Form 


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.

This payment plan agreement is made and entered into as
 of the ________day of _______ 2025 by and between 
Sparkly Housekeepers LLC 
and 
Client Name: 
Address:
 Services being requested by client agrees to pay
 Sparkly Housekeepers LLC the total amount of $____________ for each cleaning 
services scheduled to be paid as follows....
 Payment amount $________ 
Payment Frequency ...... 
 Every Scheduled service 
 Monthly Payment being made monthly will be due on the ______ of every month
 by 5p.m.
 Client Signature:
 Client Print Name:
 Date: ________ Time: _____________ 
By signing the client understands this a binding agreement of payments

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.

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