Current Client Information: 

Name: _______________________________ 

Date: ____________________________ 

Referred Client information: 

Name: ______________________________ 

Address: ______________________________________________________

 Called Sparkly Housekeepers LLC? Yes / No 

Did a walk through with Sparkly Housekeepers LLC? Yes / No

 Scheduled A service with Sparkly Housekeepers LLC? Yes / No

 Finished first service with Sparkly Housekeepers LLC? Yes / No 

Canceled first service with Sparkly Housekeepers LLC? Yes / No 

Referral Discount Activated? Yes / No Referral Client Notified of Final results? Yes/No 

Discount Applied to Referral Clients account? Yes / No 

Employee Signature: ___________________________ 

Date: _____________________ 

Employee Name:______________________

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.