Denali Clean - Carpet Cleaning and Restoration Services, Inc.

CONTACT INFORMATION: Algonquin IL 847-844-3434 Crystal Lake, IL 815-788-0200 Palatine, IL 847-991-4900
Your Name :	* REQUIRED
Your Phone :	* REQUIRED
Your Email :	* REQUIRED
Street :	* REQUIRED
City :	* REQUIRED
State :
Zip Code :

ESTIMATE INFORMATION CARPETING:

1. Which rooms need carpet cleaning?

	Living room		Kitchen
	Dining room		Stair Landing
	Hall(s)		Bedroom(s)
	Entry		Stairs
	Bathroom(s)		Other

2. Please describe your home or apartment.

Home - one story
Home - two stories
Home - Three stories or more
Apartment What Floor ? PLEASE INDICATE A NUMBER

How many rooms? PLEASE INDICATE A NUMBER

3. What level of preparation is necessary?

Only clean exposed carpet area
Move furniture and clean entire carpet

.4. Which problems or services will need special attention? (Check all that apply)

	Oil or grease spots		Water spots
	Pet stains		Soil filtration
	Stain Guard Protection		Soiling spots
	Food / liquid stains		Rust spots
	Odor elimination		Other

5.HOW SOON WOULD YOU LIKE THE WORK TO BE COMPLETED ?
PLEASE INDICATE A DATE

ESTIMATE INFORMATION UPHOLSTERY & OTHER:

1. Which furnishings do you want to have cleaned? (Check all that apply)

	Sofa	Loveseat
	Armchair	Dining Room Chairs
	Sectional Sofa	Ottoman
	Recliner	Walls/ Ceilings Mattresses
What Type of Matresses King Queen Full Double Twin Toddler Other

2. What kind of fabric/padding do you want to have cleaned?

Cotton Leather Other

3. Would you like a protective coating such as Teflon, Scotchgard, etc. applied?

Yes No Not Sure

Estimate Information Flood / Smoke Damage:

1. Please choose which has happened?

Flood / Water Damage Small Fire Smoke Damage

2. What section of your location did this happen in ?

PLEASE INDICATE A LOCATION i.e. basement

3. Have you contacted your insurance provider yet?

ADDITIONAL INFORMATION, example - BEST TIME TO CONTACT YOU, WORK PHONE NUMBER

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