Cleaningforareason.org | The foundation that cleans homes for women with cancer

How Does It Work?

Fill out the form below to request maid services. If there is a participating maid service in your area you will be asked to furnish a "proof of treatment" statement from your doctor and you'll need to sign and submit the "patient waiver". Upon receipt of these two documents you will be contacted by an Official Cleaning For A Reason Partner in your city. Four free cleanings will be offered once a month for four months. We'll focus on your house while you focus on your health.

To request services for your home, please fill out the following information and submit. You will be contacted within 3 to 5 business days. Thank you for your patience as we try to handle the volume of requests made for benevolence cleaning.

Your Name:

Telephone Number:

Cell Phone Number:

Email Address:

Street Address

City:

State:

Zip:

How did you hear about us?

I am requesting maid services for a friend or loved one.

I would like to sponsor a cancer patient

I wish to make a donation on someone's behalf  (we will contact you)

I would like to hold a fundraiser to help sponsor a cancer patient. Her name is:

Name:

City:

State:

Are you currently undergoing treatment for cancer?

yes     no

Comments:

IMPORTANT: Please check the MAID SERVICE tab to see if there is a participating maid service in your area.   Not all areas have a cleaning service Partner. We apologize if we do not have a service Partner in your area.

Please have your doctor's office fax a note specifying the length of your cancer treatment to: Cleaning For A Reason: (972) 221-7912 - Your request will not process until this information is received (be sure your name is on the fax, along with the doctor's address and phone number).

Please tell us a little bit about your home so we can better serve your needs:

One Story house:

Two Story house:

Square footage:

# of Occupants:
# of Pets:

# of Bedrooms:
# of Bathrooms:

Condition of the home (dust & build up):

Good     Fair     Average    Poor

Other helpful information:

How soon would you like to begin service?

ASAP     FLEXIBLE

I am interested in making a financial donation:

Please contact me by: Email Telephone

Your Name:
Telephone Number:
Cell Phone Number:
Email Address:
Street Address
City:
State:
Zip:
How did you hear about us?

		I am requesting maid services for a friend or loved one.
		I would like to sponsor a cancer patient
		I wish to make a donation on someone's behalf (we will contact you)
		I would like to hold a fundraiser to help sponsor a cancer patient. Her name is:
Name:
City:
State:
Are you currently undergoing treatment for cancer?
yes no
Comments:

IMPORTANT: Please check the MAID SERVICE tab to see if there is a participating maid service in your area. Not all areas have a cleaning service Partner. We apologize if we do not have a service Partner in your area.

Please have your doctor's office fax a note specifying the length of your cancer treatment to: Cleaning For A Reason: (972) 221-7912 - Your request will not process until this information is received (be sure your name is on the fax, along with the doctor's address and phone number).

Please tell us a little bit about your home so we can better serve your needs:

One Story house:		Two Story house:

Square footage:
# of Occupants:		# of Pets:
# of Bedrooms:		# of Bathrooms:

Condition of the home (dust & build up):
Good Fair Average Poor

Other helpful information:


How soon would you like to begin service?
ASAP FLEXIBLE