Carpet & Upholstery Cleaners Call Today! 816-461-7000
Carpet Cleaning & Repair		Upholstery Cleaning		Area Rug Cleaning			Drapery Cleaning		Ceramic & Marble Cleaning		Carpet & Fabric Protection
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If you would like to set an appointment, please fill out the information below and we will contact you on the next business day.

Name

Phone

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Which of the following services are you interested in?
	Carpet Cleaning & Repair	Drapery Cleaning
	Upholstery Cleaning	Ceramic & Marble Cleaning
	Area Rug Cleaning	Carpet & Fabric Protection

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How often do you have your carpets professionally cleaned?
	1-3 months	Once a year
	4-6 months	Never

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How did you hear about Company Name?
	Yellow Pages	Direct Mail
	Internet	Other
	From a friend

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When is the best time to reach you?
	Morning	Afternoon	After 5 p.m.

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Campbell’ Carpet & Upholstery Cleaners
1030 w. 23
Independence, Mo. 64055
816-461-7000
campbellscarpet.com

© 2003 Company Name. All rights reserved.