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*:

Studio1 1/22 123 1/24 1/25 1/26 1/27 1/2Other

Smoker:

YesNo

Pets:

NoneCatDogOther :

Services required*:

Regular housekeepingMajor cleaningOdd jobs

Frequency:

Once weeklyOnce every 2 weeksOnce every 4 weeksOn calll

Number of hours per visit:

3 h (4⅟2 or smaller)3.5h4h4.5h5h6h7h

Method of payment:

ChequePreauthorized debit/Automatic withdrawalCredit card