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Cellulosic Browning- Why Did My Carpets “Brown” After Carpet Cleaning?
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Carpet Dyeing Intake Form
Carpet Dyeing Intake Form
Please enable JavaScript in your browser to complete this form.
Name
*
First
Last
Email to send you your Appt time
*
Your Street Address (required)
*
Your City (required)
*
Your Zip (required)
*
Cell Phone # and Work or Home # (required)
*
Who Are You?
I'm the Homeowner
I'm Renting
Contractor/Cleaning Company
Commercial Client
Who Caused the Damage?
Homeowner
Tenant
Commercial Client
3rd Party Cleaning Company/Contractor
What type of Service(s) do you need? (Choose ALL that apply)
Bleach Spot Repair/Carpet Dyeing
Tough Stain Removal
Carpet Cleaning
Carpet Patch(es)
Carpet Repair(s) misc.
Carpet Stretching
Other
What Size Are Your Bleach Spots? AND Quantity? Size of Each, Location of Each? Example: Area 1 Name, size; Area 2 Name, size;( Ie. Are Your Bleach Spots: Golf Ball, Baseball, softball, Volleyball, Beach Ball size etc?)
example: Master Bedroom: 2 Baseball size spots; Hallway:16 Golf Ball size & 2 Beach Ball Size spots
What is the closest color of the bleach spots?- Please Select
Orange
Yellow
White
Peach
Pink/Lavender
What is your type of Carpet- Please Select
Polypropylene or Apartment Carpet
Nylon Carpet
Wool Carpet
Please Select Cause of Damage:
Bleach
Pet Urine
Toilet Bowl Cleaner
Resolve-Folex/Other Similar Spot Cleaning Chemical
Wine/Coffee/Dirt/Food/Grease
Other or Unknown Stain
After Bleach Spot, did you put a chemical on it yourself?
Yes, I tried to Fix It myself
No, After bleach spot, I haven't touched it
If Yes, what chemical(s) did you put in the carpet that still remain?
Is the bleach spot carpet dirty?
Dirty Carpet
Clean Carpet
After Bleach Spot, did you attempt to dye it yourself or put RIT dye (or similar) on it yourself?
Yes, I tried to Dye It myself
No, After bleach spot, I haven't touched it
1st & 2nd Choice For Appt: Date & Time
please select your 1st & 2nd option so we can accomodate you if at all possible
Is there anything you specifically want to ask us or Additional info to tell us?
FINAL INSTRUCTIONS: (1) We Need a picture of the entire room with the bleach spots/damage in it. Send each room separately and each individual damage/spot in that room separately. (2) We Need a closeup with a pen next to the patch/bleach spots to determine scope & size of patch/spots (3) Send each room separately and each individual damage/spot in that room separately. (4) Try to count each patch or spot(s)
Yes, I texted them
Yes, I uploaded them here below under 'File Upload'
No, I did not
I emailed them instead
File Upload
Click or drag files to this area to upload.
You can upload up to 20 files.
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Carpet Dyeing Intake Form
was last modified:
October 31st, 2022
by
admin