Effective Date: ______________________

Customer Name: __________________________________________

Service Address: _________________________________________

City/State/ZIP: ___________________________________________

Phone: _________________________________________________

Email: __________________________________________________

Emergency/Family Contact (optional): _______________________

Relationship: ____________________________________________

Phone: _________________________________________________

Senior Solutions Cleaning LLC is committed to providing dependable, respectful, and professional cleaning services.

Our goal is to help seniors and their families maintain a clean, comfortable, and welcoming home.

We will treat your home, belongings, privacy, and personal space with care and respect.

Please select your service:

☐ Weekly Signature Cleaning

☐ Biweekly Signature Cleaning

☐ Every 4 Weeks Signature Cleaning

☐ One-Time Cleaning

Scheduled Day: __________________________________________

Approximate Arrival Time: _________________________________

Price Per Visit: $_________________________________________

Your Signature Cleaning may include:

• Countertops
• Sink and faucet
• Stovetop
• Exterior of appliances
• Microwave
• Cabinet fronts
• Table and chairs
• Floors
• Trash removal

• Toilet
• Sink and countertops
• Tub/shower
• Mirrors
• Faucets
• Floors
• Trash removal
• High-touch areas

• Dusting
• Vacuuming/sweeping
• Mopping
• Bed making
• One linen change when linens are provided
• Light straightening
• Trash removal

• Dusting
• Vacuuming/sweeping
• Mopping
• Light straightening
• High-touch surfaces
• Trash removal

Each Signature visit may include one rotating detail task, such as:

• Additional dusting
• Kitchen detail
• Bathroom detail
• Linen/bedroom refresh
• Accessible baseboard spot-cleaning
• Light organizing

Additional services may be requested for an additional fee.

  Service Price     Laundry $25/load   Extra bed linen change $15/bed   Inside refrigerator $35   Inside oven $35   Baseboards $40–$60   Light organizing $40/hour   Interior windows $8/window   Additional bathroom $30   Heavy pet hair $25–$50    

Additional services will be discussed with the customer before additional charges are made.

A first-time cleaning may require additional time because the home has not yet been placed on a regular cleaning schedule.

First-Time/Fresh Start Cleaning Price: $____________________

After the initial cleaning, customers may select a weekly, biweekly, or every-4-weeks Signature Plan.

We accept:

☐ Credit/Debit Card

☐ ACH/Bank Payment

☐ Check

☐ Cash

☐ Other: __________________________________

Payment is due: _________________________________________

If a family member is paying for the service, the customer may authorize that person below.

Senior Solutions Cleaning welcomes family members who want to arrange and pay for cleaning services for a loved one.

Authorized Family Member: _________________________________

Relationship: ____________________________________________

Phone: _________________________________________________

Email: __________________________________________________

The customer authorizes this person to:

☐ Schedule appointments

☐ Reschedule appointments

☐ Receive invoices/receipts

☐ Make payments

☐ Receive cleaning-service confirmations

The Company will limit communications to information necessary for arranging and paying for services.

With the customer's permission, Senior Solutions Cleaning may send the designated family contact a simple confirmation after a cleaning.

For example:

"Today's scheduled cleaning has been completed. Your next appointment is __________."

This is a cleaning-service confirmation only.

Senior Solutions Cleaning does not provide medical assessments, medical care, wellness checks, or emergency monitoring.

We will make every reasonable effort to arrive during your scheduled time window.

Arrival times may occasionally change because of traffic, weather, emergencies, or the length of previous appointments.

We will notify you when significant delays or changes occur whenever reasonably possible.

Please provide at least 24 hours' notice when canceling or rescheduling.

Cancellation with less than 24 hours' notice may result in:

Cancellation Fee: $________________

The Company may waive the fee for emergencies or other circumstances at its discretion.

The customer must provide safe access to the home.

Access may be provided by:

☐ Customer present

☐ Key

☐ Lockbox

☐ Access code

☐ Family member/caregiver

☐ Other: __________________________________

If our cleaning professional arrives and cannot safely access the home, a cancellation/lockout fee may apply.

Lockout Fee: $________________

Please tell us about pets in the home.

Pets: _________________________________________________

For everyone's safety, we may ask that pets be secured while cleaning is being performed.

We want our customers and cleaning professionals to remain safe.

We may decline or stop service if we encounter dangerous conditions such as:

• Dangerous animals
• Hazardous materials
• Severe pest infestation
• Unsafe structural conditions
• Biohazards
• Excessive mold
• Threatening or unsafe behavior
• Other serious safety concerns

If a situation is outside our normal cleaning services, we will explain the issue and discuss possible options.

Senior Solutions Cleaning is a cleaning and light housekeeping company.

We do not provide:

• Medical care
• Nursing care
• Medication assistance
• Bathing
• Toileting
• Dressing assistance
• Personal-care services
• Medical transportation
• Heavy lifting
• Pest control
• Mold remediation
• Biohazard cleanup
• Hoarding remediation
• Plumbing or electrical repairs

If you need one of these services, we recommend contacting an appropriately qualified professional.

Please secure valuable, fragile, sentimental, or important belongings before cleaning.

Customers should not ask cleaning personnel to handle:

• Cash
• Jewelry
• Medication
• Important documents
• Firearms
• Other highly valuable or sensitive items

The Company is not responsible for pre-existing damage, normal wear and tear, or damage resulting from defective or improperly installed items.

We use household cleaning products appropriate for normal residential cleaning.

Please tell us about any:

• Allergies
• Product sensitivities
• Specialty surfaces
• Natural stone
• Specialty flooring
• Delicate furniture

Special instructions:

We want you to be happy with your cleaning.

If something was missed or does not meet the agreed cleaning scope, please contact us within 24 hours of service.

We will review the concern and, when appropriate, work with you to correct the issue.

We cannot guarantee removal of permanent stains, damage, discoloration, mold, rust, or conditions that cannot reasonably be removed through ordinary cleaning.

We respect your privacy.

We will not intentionally share your personal information with others except when:

• You authorize us to do so;
• It is necessary to provide the requested service;
• It is required by law; or
• It is necessary to address an emergency or safety concern.

We will not use photographs of your home or belongings for advertising without your permission.

☐ YES, I authorize photographs to be used for marketing.

☐ NO, I do not authorize photographs for marketing.

Customer Initials: __________

Either the customer or Senior Solutions Cleaning may end recurring services.

The customer may cancel recurring services by contacting the Company.

The Company may discontinue service because of circumstances such as:

• Repeated nonpayment
• Unsafe conditions
• Threatening behavior
• Repeated access problems
• Services outside the Company's scope

By signing below, I confirm that:

☐ I have read and understand this agreement.

☐ I understand what is included in my cleaning service.

☐ I understand the pricing and payment terms.

☐ I understand the cancellation policy.

☐ I understand that Senior Solutions Cleaning provides cleaning and light housekeeping services and not medical or personal-care services.

☐ I have had an opportunity to ask questions about the agreement.

Printed Name: ___________________________________________

Signature: ______________________________________________

Date: ______________________

Printed Name: ___________________________________________

Relationship: ____________________________________________

Signature: ______________________________________________

Date: ______________________

Representative Name: ____________________________________

Title: ___________________________________________________

Signature: ______________________________________________

Date: ______________________

Senior Solutions Cleaning LLC

Business Location: Columbia, South Carolina

Service Area: Columbia & Surrounding Midlands

Phone: 839 290-5333 

Email: seniorsolutionscleaning1@gmail.com

__________________________________________________

Website: ________________________________________________

Business Hours: _________________________________________