A client is applying for domestic services and needs to provide contact information. The application form requests the client's title, names, gender, residential and physical addresses, contact details, and which services are needed such as house helper, nanny, or cleaner. The client must also specify if the domestic worker should sleep in or out, how many times per week help is required, and the preferred age of the worker. The client and consultant signatures are needed along with dates to finalize the application.