Client Profile Form

Personal Information

First Name:

Last Name:

Home Address:

City,State & Zip code:

Home Phone Number:

Cell Phone Number:

Email Address:

Work Address:

City,State & Zip code:

Work Phone Number:

Your Birthday: Month ---JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Day ---01020304050607080910111213141516171819202122232425262728293031

Special Person's Birthday

Name: Month ---JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Day ---01020304050607080910111213141516171819202122232425262728293031

Wedding Anniversary

Month ---JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Day ---01020304050607080910111213141516171819202122232425262728293031

How did you hear about us? ---WebsiteReferralAdvertisementMailingValet ParkingPerk PlaceOther

I am most interested in? ---Errand ServicePet ServicesCorporate ServicesPersonal ShoppingPerks ProgramValet ParkingCleaning serviceHome ManagementEvent Planning

I imagine that I will utilize the services approximately: ---Occasionally1-4 hrs./month4-8 hrs./month8-12 hrs./month14+ hrs./month

Family Information

Family Members Name: Relation: ---WifeHusbandSonDaughterMotherFatherMother-in-LawFather-in-LawAuntUncle Month ---JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Day ---01020304050607080910111213141516171819202122232425262728293031

Family Members Name: Relation: ---WifeHusbandSonDaughterMotherFatherMother-in-LawFather-in-LawAuntUncle Month ---JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Day ---01020304050607080910111213141516171819202122232425262728293031

Family Members Name: Relation: ---WifeHusbandSonDaughterMotherFatherMother-in-LawFather-in-LawAuntUncle Month ---JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Day ---01020304050607080910111213141516171819202122232425262728293031

Family Members Name: Relation: ---WifeHusbandSonDaughterMotherFatherMother-in-LawFather-in-LawAuntUncle Month ---JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Day ---01020304050607080910111213141516171819202122232425262728293031

Family Members Name: Relation: ---WifeHusbandSonDaughterMotherFatherMother-in-LawFather-in-LawAuntUncle Month ---JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Day ---01020304050607080910111213141516171819202122232425262728293031

Family Members Name: Relation: ---WifeHusbandSonDaughterMotherFatherMother-in-LawFather-in-LawAuntUncle Month ---JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Day ---01020304050607080910111213141516171819202122232425262728293031

Your or Significant other's Favorite Flower's and/or sweets:

Would you prefer a ride to the Airport? ---YesNo

Dry Cleaning

Starch on: shirts ---LightMediumHeavy Pants: ---LightMediumHeavy

Will you need assistance with any of these?

Home Services

Home Cleaning: ---YesNo

Laundry Care: ---YesNo

Home Organization: ---YesNo

Shopping

Personal Shopping: ---YesNo

Gift Shopping: ---YesNo

Grocery Shopping: ---YesNo

Auto Service

Oil Change: ---YesNo

Take in for Service: ---YesNo

Cleaning or Detailing: ---YesNo

Lifestyle Management

Home Management Program: This is where we schedule cleanings, laundry care & dry cleaning care, grocery shopping, and/or auto care to help you focus on what's more important in life. ---YesNo

What type of events do you enjoy attending?

What is your least favorite task to do?

What service do you feel you will use the most/least?

What is your goal for using our service?

Comments: