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123-456-7890

Neely's Downsizing and De-Hoarding Services Application Form

Eligibility Requirements:

Applicants must reside in Ontario, Canada.
Must be 18 years or older.
Must have ownership or decision-making authority over the property.

Please complete the following application form to the best of your ability. This information will help us understand your situation and determine how we can best assist you.

First name*

Last name*

Email*

Phone*

Birthday

Please verify your are above 18 years of age.

Address*

Property Information:

Do you own or have decision-making authority over the property?*

Yes

Is there a driveway that can be used during the cleanup work?*

Yes

How long have you been living at this property? *

Briefly describe the state of the property *

Additional Assistance

Do you require any additional help or services (e.g., emotional support, counseling, medical assistance)? *

Yes

If yes, please specify:

Potential Hazards

Are there any hazards present on the property that we need to be aware of (e.g., black mold, rat droppings, mouse droppings, bed bugs, etc.)? (Yes/No): *

Yes

If yes, please specify:

Confidentiality Agreement:

Do you agree to allow us to take before and after photos/videos of the property (without identifiable markers) for our records and improvement purposes? (Yes/No): *

Yes

Are you willing to provide a review of our services once the cleanup is completed? (Yes/No):*

Yes

Legal Questions:

Have you ever been involved in any legal disputes or actions regarding the property? (Yes/No): *

Yes

If yes, please provide details:

Additional Information:

Please provide any additional information you think might be relevant to your application:

If available, please provide any photos to help us assess

Signature and Date:

By signing this application, I confirm that the information provided is true and accurate to the best of my knowledge. I understand that this information will be used to assess my eligibility for Neely's Downsizing and De-Hoarding Services.

Signature*

Date*

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