GOLD STAR CLEANING

1800 Lime Rock Dr, Round Rock, TX 78681 PHONE: (512) 773-0212

www.goldstarcarpetcleaning.com

Pre-existing Conditions Previous water damage or rings Woven Carpet/Rugs Urine Filtration soiling Ripples, Tears or Holes Upholstery: Possible dye migration after cleaning Traffic area abrasion Rust, Coffee or Tea

Room(s)

Notes: Could be permanent. Woven carpet could shrink. Loose woven rugs to be cleaned in-plant. Urine can cause permanent staining. Cleaning spots may increase odor temporarily. See Urine Soiling Notice. See Filtration Soiling Notice See Carpet Repair Service If dye transferred during testing, there is a possibility that fabric may bleed during cleaning. Will still be visible after cleaning Could be permanent Floor finish floor around and under loose rug may be affected by moisture. Any cleaning May discolor May not come completely out. Heat Transfer Method may discolor carpet around spot. See Fabric Protector Notice

PROFILE and SAFETY PRECAUTION FORM

CARPETED SURFACES, AREA RUGS, UPHOLST ERY AND DRAPERIES

Date of Job ____________________

Technician _________

Asst__________

Last Name or Business Name_________________________________________________ Phone #___________________ What prompted you to have cleaning done today? Construction Tufted/Woven
(Woven see Notice)

PQ

Room/ Piece

Fiber Type

Age

Color

Size

Service

Price

Wood Floor under rug Sisal or Seagrass Colored spots such as red, blue, green, yellow & black Need for Fabric Protection

Upholstery Notice: In recent months, the carpet cleaning industry has experienced a higher than usual number of occurrences of Indicator Dye Discoloration. This is a condition where dyes react adversely to any cleaning that is done to the fabric. Gold Star Cleaning will take every precaution to prevent this occurrence, but cannot guarantee to avoid it. By signing below, you agree to hold Gold Star Cleaning harmless for any such occurrence. Thank you for your cooperation. I acknowledge that these conditions exist in my carpet/upholstery and have read and understand the notices outlined in this document.

Important Safety Precautions It is our sincere desire that you and your family are completely safe while we are working in your home. Please help us accomplish that by reading and signing this form. Our technicians are not allowed to begin work without this form. Thank you! 1. 2. 3. Please remove nick-knacks and breakables. Keep children and pets away from hoses, equipment, cleaning products, and work area. Keep children and pets off of carpet or floors for 6 hours or until completely dry to the touch. Keep children and pets off of furniture for 12 hours or until completely dry to the touch. Keep children and pets away from truck. Walk on carpet at your own risk until completely dry. Floors may be slippery when wet. Please advise all occupants of this hazard. Please keep caution signs (provided) where carpet meets hard floor until completely dry. Do not allow our technician to operate truck-mounted machine inside garage, carport or any other structure.

CODES: Living Room: LR, Dining Room: DR, Family Room or Den: FAM, Hall: HA, Bedroom: BR, Master Bedroom: MBR, Closet: CLST, Stairs: STR. Sofa: SFA, Lovesear: LVS, Chair: CHR, Ottoman: OTM CODES for Fiber Type: Synthetic(Nylon, Olefin, Polyester): SYN, Natural(Wool, Cotton): NAT SPECIALTY (Sisal, Seagrass, Silk, Rayon, Linen): SPCL Has carpet / upholstery been cleaned before? Y/ N How long ago? ________________________________

Was fabric protection applied when cleaned? Y / N If yes, did it seem to work? Y / N

Who was it cleaned by?_________________________ Does anyone in the home have allergies? Y / N *Circle one: accept / decline fabric protection at this time. Please have technician provide demonstration of fabric protector.

4. 5. 6. 7.

Client Signature_____________________________________ Date_____________

I have done a thorough post-inspection with the technician. I agree that all steps as outlined in the brochure have been satisfactorily completed (dry bonnet only needed on berber and commercial carpet). No damage has been done to my property.

Paid by:

CC

Check

Cash

Net 30

* I understand and agree to observe safety precautions listed above. Client Signature_____________________________________ Date_____________

Technician Signature: _______________________________