Thank you for considering Certified Chem-Dry for your cleaning needs. We will check our schedule and contact you within one working day to discuss your estimate, confirm your appointment or follow-up with any other requests made through this online form.

If you have an urgent need for any of our services, please call us immediately at one of the numbers listed on the top of this page.

The information collected in this form is confidential and used solely for Certified Chem-Dry and will not be shared or sold to any outside party.

First Name
Last Name
Company Name
E-Mail Address
Day Phone
Evening Phone
Fax Number
Service Address
City
State
Zip
Preferred Contact Method
How did you hear about us?
Reason for contact?
 Cleaning Appointment
Cleaning Estimate
Additional Information
Service Type
 Residential Service
Commercial Service
Services Needed
 Carpet Cleaning
Area Rug Cleaning
Upholstery Cleaning
Pet Urine and/or Odors
Other (please list below)
Areas to be cleaned
 Living Room
Dining Room
Front Room
Den/Office
Hallway
Kitchen
Stairs
Number of Bedrooms
Other (please list below)
Please explain any other cleaning to be done
First appointment choice
 Date (mm/dd/yy):
Time
Second appointment choice
 Date (mm/dd/yy):
Time

Other comments or notes

 
 
 

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Saturday, August 27, 2005