Cleaning Service Supplies Order Form

Please fill out all relevant fields with accurate information to complete your order.

Ordered By:

Buyer Name:	[Buyer Name]
Address:	[Buyer Address]
Number:	[Buyer Number]
Email:	[Buyer Email]

Deliver To:

Receiver Name:	[Receiver Name]
Address:	[Receiver Address]
Number:	[Receiver Number]
Email:	[Receiver Email]

Order Details

Supplies Description	Quantity	Unit Price	Total Price
All-Purpose Cleaner (1 gal)	5	$10.00	$50.00
Microfiber Cleaning Cloths	10 packs	$8.50	$85.00
Mop Heads	3	$15.00	$45.00
Vacuum Cleaner Bags	2 boxes	$20.00	$40.00
Disposable Gloves	1 box	$12.00	$12.00
Trash Bags (30 gal)	4 boxes	$18.00	$72.00
Window Cleaner Spray (32oz)	8 bottles	$5.00	$40.00
Broom	2	$10.00	$20.00
Total			$364.00

Payment Information

Payment Method:

• Credit Card

• Check

• Cash

• Other:                               

Billing Address (if different from delivery address): [Billing Address]

Delivery Information

Delivery Date Requested: [Delivery Date Requested]

Special Delivery Instructions:

Please deliver the order to the rear entrance of the building between 9:00 AM and 5:00 PM Monday through Friday.

Terms and Conditions

• All sales are final. No returns or exchanges unless goods are defective.

• Payment is due upon receipt of invoice unless credit terms have been established.

• Late payments are subject to a [X]% late fee per month.

This form serves as an official request for the listed items. By signing below, the customer agrees to the terms and conditions outlined above.

[Buyer Name]

[Date]

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