Online Order/Quote Request Form First Name: Last Name:  Street Address:  *City: State:  -- AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip:  Phone (1): Phone (2) :   Which is best to call from 9am-5:00pm? Phone 1 Phone 2   E-Mail Address: Service Category Corporate Services Entertainment Errands Home Services Property Management Services Travel Services Anticipated Start Date: Sunday Monday Tuesday Wednesday Thursday Friday Saturday 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 January February March April May June July August September October November December 2004 2005 2006 2007 Anticipated End Date: Sunday Monday Tuesday Wednesday Thursday Friday Saturday 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 January February March April May June July August September October November December 2004 2005 2006 2007 Service Details: Terms and Conditions: Cleveland Premier Concierge (CPC) hereby agrees to provide general concierge services to “client” in accordance with this agreement. 1. CPC shall provide all such lawful services as are requested by the Client. 2. CPC shall contract with others as needed to provide the services requested. CPC shall use its best effort to obtain qualified providers of such services, but no guarantee is given as to the quality of services provided by others. CPC is not liable for any unsatisfactory services provided by any other businesses. 3. Client understands and agrees that CPC shall not be liable in any manner for any loss, damages or claims that arise from the furnishing of services to Client by any subcontractor, including any consequential damages that may arise from the furnishing of such services. 4. Client understands that in order for CPC to provide car service, the client must have full auto insurance coverage and gives permission for CPC representatives to drive client vehicles for repair, wash, oil change and other car services as agreed to by client and CPC 5. CPC shall receive compensation for its services as follows for time expended by principals of CPC: Payment shall be as follows: • 50% Prior to Service • 50% Upon completion • $25 per hour. Errand services are billed by the hour and not by the task. The $25 per hour rate does not include event or party planning. Please contact one of our Event Coordinators for party/event planning rates. Rates reflect charges for services rendered by Cleveland Premier Concierge and do not include charges for outside vendor services or merchandise purchased to complete request. 6. In the event that a disagreement occurs, which cannot be resolved by the parties involved, mediation will be the first avenue for settlement. In the event of any dispute under this agreement that can not be resolved through mediation, the prevailing party shall be entitled to recover attorney fees and other costs reasonably incurred by it in connection with such dispute, whether or not litigation becomes necessary. 7. Only a writing signed by both parties may modify this agreement. I Agree to the Terms and Conditions   PLEASE VERIFY ALL OF YOUR INFORMATION IS ACCURATE BEFORE SENDING. THANK YOU!