Client Name: ___________________________________ 

Address: ________________________________________ 

City, State, Zip:___________________

 Email Address: __________________________________ 

Phone Number: __________________________________ 

Date of Birth: ___________________________________ (hereinafter referred to as "Client") 

And 

Sparkly Housekeepers 

 Oregon WI, 53575

 608-709-9709

 sparklyhousekeepers@gmail.com

 Credit Card Information

 ⦁ Full Name: ____________

 ⦁ Phone Number: ____

⦁ Email Address: _________

 ⦁ Date of Birth: ___________

 ⦁ Credit/Debit Card Number: ________

 ⦁ Credit/Debit Card Exp.: ______

⦁ Number of Children in Home: _______

 ⦁ Number of Animals in Home: ________

⦁ Names of All Adults living in Home: ______________

Permission for Use of Information the Client grants

 Sparkly Housekeepers LLC permission to utilize the provided

 personal information for the purpose of providing housekeeping services. 

The Client specifically authorizes the use of the credit card 

information for payment of services rendered as agreed 

upon in this agreement Retention of Information the Client

 agrees that all personal information provided will be retained on file 

by Sparkly Housekeepers LLC. 

The Client acknowledges and understands that:

 ⦁ Only the credit card information will be deleted from 

Sparkly Housekeepers LLC 

records upon termination of the contract by either party. 

⦁ All other personal information will remain on file, for up to 7 years. 

⦁ Credit/Debit card will only be charged upon cleaning service 

and/or other charges that are specified in the service agreement form. 

Confidentiality Sparkly Housekeepers LLC agrees that all personal

 information collected will be kept confidential and will not be 

disclosed to any third parties without the prior written consent of the Client,

 except as required by law.

 Termination of Agreement 

2 This Agreement may be terminated by either party upon written 2-week notice.

 Upon termination, Sparkly Housekeepers LLC will delete the credit card information from its records, 

while other personal information will remain on file unless a written request for deletion is 

received from the Client and Accepted by Sparkly Housekeepers LLC. 

Sparkly Housekeepers LLC will notify the client with the final decision with 5 Business Days. 

Sparkly Housekeepers LLC does not need to present a reason of decision to client.

 Entire Agreement This Agreement constitutes the entire understanding between 

the parties with respect to the subject matter hereof and supersedes all prior 

discussions, agreements, and understandings of any kind. 

Acknowledgment and Acceptance By signing below, the Client acknowledges 

that they have read, understood, and

 agree to the terms and conditions set forth in this Agreement.

 Sparkly Housekeepers LLC:

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.