Estimate request

Please complete the form below to help us prepare an estimate for your Plumeau chiffon et compagnie package. We will then contact you to make an appointment

Fields marked with an asterisk (*) are required information.

Personal information

Last Name*:
First name*:

Address*:
City* :

Postal Code:

Telephone (home)*:

Telephone (other):

Email*:

Health Insurance Number (for subsidy purposes):

Type of client*

 Senior citizen (age 65+) Referral† General public (under age 65)
 Other :
† Person with a functional limitation who has been referred by a CSSS.

Apartment size*:

 Studio 1 1/2 2 12 3 1/2 4 1/2 5 1/2 6 1/2 7 1/2 Other

Smoker:

 Yes No

Pets:

 None Cat Dog Other :

Services required*:

 Regular housekeeping Major cleaning Odd jobs

Frequency:

 Once weekly Once every 2 weeks Once every 4 weeks On calll

Number of hours per visit:

 3 h (4⅟2 or smaller) 3.5h 4h 4.5h 5h 6h 7h

Method of payment:

 Cheque Preauthorized debit/Automatic withdrawal Credit card

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