Page 1 of 2

NirvaM Client Service Request

Thank you for considering NirvaM Business & Executive Services. Please complete this form to tell me about the support you need. Submitting this form does not create a service agreement. I will contact you to discuss availability, pricing, and next steps.

Full name

*

Business or organization name

Email address

*

Telephone number

*

Preferred contact method

*

A

Email

B

Phone Call

C

Text

Client type

*

A

Executive

B

Business or Organization

C

Entrepreneur

D

Individual

Services needed

*

Description of assistance needed

*

Request type

*

A

One-time task

B

Short-term project

C

Ongoing support

D

Not sure

Estimated hours

*

A

Less than 1 hour

B

1–5

C

6–10

D

11–20

E

More than 20

F

Not sure

Desired start date

*

Deadline

Urgency

*

A

No

B

Within 48 hours

C

Same day

D

Weekend support

Preferred language

*

A

English

B

French

C

Haitian Creole

D

Spanish

How did you hear about NirvaM?

Additional information

Agreement

*

I agree that services, pricing, deadlines, and payment terms must be approved before work begins.