Name:_____________________________ 

Date:_____________________________ 

Address:__________________________________________________________________ 

Type of Discount: 

10% First Time Service 

20% BI – Weekly Service 

15% Monthly Service 

20% Referral Service

 ...................Do Not Fill Out below this point................Employees Only............................. 

Employee Name:__________________

 Date: _________ Time: ________ A.M. / P.M. 

Approved? Yes / No

 Reason Denied: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________

 Employee Signature: ______________________________________

 Date:_______________

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.