First Name*
Last Name* (required)
Email*
Phone Number*
Company Name*
Job Title*
Industry*
Do you have a confirmed case of COVID-19 that was in your building? YesNoPossible
What is the state of the business?* Open and most people are still occupyingOpen but only essential employeesClosed and looking to open again
What option best describes your situation?* One buildingMultiple buildings next to each otherMultiple buildings in the same townMultiple buildings in different townsMultiple buildings in different states
Are you declared an essential business?* YesNo
What Type of disinfection services are you looking for?* One TimeOngoing dailyOngoing sporadicallyNone (Only Janitorial)
What kind of janitorial services are you looking for?* None (Only Disinfection)1 day a week ongoing2 days a week ongoing3 days a week ongoing4 days a week ongoing5 days a week ongoing6 days a week ongoing7 days a week ongoing
I need to have the disinfection done by this date*
Please provide any optional information that may assist us such as square footage or detailed requests.
