Business Entity Name (If individual, please enter name plus any applicable DBA)
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email address
*
Phone Number
*
Would you like us to text you regarding this quote?
*
Yes
No
Website Address (If you have one)
How many years have you been in business?
If new venture, please enter 0
If this is a new venture or you've been in business less than 3 years, describe your experience and qualifications in the pest control industry.
In what states do you conduct business?
*
Total gross annual sales
*
Total annual payroll
*
If you have no employees, please enter 0 for payroll.
Number of full-time employees:
If none, please enter 0
Number of part-time employees:
*
If none, please enter 0
Describe your employee training process, if applicable
*
Does your pre-employment screening include background checks and drug testing?
*
Yes
No
Are you a member of any trade organizations/associations?
If yes, please list
Have you had any insurance claims in the last 3 years?
*
Yes
No
Please detail any claims including circumstances and amount paid out
*
What percentage of your work is
*
PEST CONTROL SERVICES (Percentage% of Annual Sales)
*
Do you perform bed bug treatment services?
*
Yes
No
Describe your bed bug treatment procedures
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Do your procedures include heat treatments?
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Yes
No
Do you use a pre-service preparation list with clients outlining their responsibilities?
*
Yes
No
Prior to conducting work, what steps are taken to protect the fire suppression systems at the job site?
*
Is the customers’ personal property removed from the treatment area?
*
Yes
No
Does the technician monitor the area receiving heat treatment?
*
Yes
No
Do you perform mosquito abatement?
*
Yes
No
Does your service involve fogging, spraying, or treatment operations applied from truck mounted
*
Yes
No
Do you provide abatement services to municipalities, communities, or public use spaces?
*
Yes
No
If you install misting systems, what precautions are taken to minimize exposure to people, pets and the environment?
*
If you do not install misting systems, enter N/A in the box
Do you treat any bodies of water?
*
Yes
No
If your services include treatment of bodies of water, list the chemicals that are used and the types of bodies of water that are treated
*
If you do not treat bodies of water, enter N/A in the box
Do you treat any bodies of water where swimming is allowed?
*
Yes
No
Do you perform any animal trapping or wildlife control?
*
Yes
No
Do your services involve the removal of potentially dangerous wildlife?
*
Yes
No
If yes, describe the trapping and removal process.
*
Are all technicians licensed and certified?
*
Yes
No
If not, please explain why
*
Do you use a written service agreement with your customers?
*
Yes
No
If not, please explain why
*
Do you provide Material Safety Data Sheets (MSDS) to each customer and discuss the hazards that exist and the precautions that must be taken regarding exposure to any chemicals?
*
Yes
No
Please explain your procedures
*
For example: Only provided upon request or written copy given to each customer.
Describe your customer record and retention procedure
*
Describe how post-application information is communicated to the customer:
*
Do you verify that images used on your webpage or marketing materials are not copyrighted or that you have obtained the proper authorization for their use from the copyright holder?
*
Yes
No
Do you use EPA “restricted use” pesticides?
*
Yes
No
List the chemicals used
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When and where are they used?
*
List your EPA license #
*
Are all “restricted use” chemicals applied by a certified applicator?
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Yes
No
How many gallons of pesticides are kept on hand at one time?
*
What precautions are taken to ensure safe pesticide storage?
*
Do you sell pesticides or any other products?
*
Yes
No
If yes, please describe
*
Have you ever received a fine, forfeiture, or disciplinary action (including but not limited to license revocation or suspension, a cease-and-desist notice or other administrative order from a governmental entity)?
*
Yes
No
If yes, please explain
*
Are technicians trained on emergency spill control procedures?
*
Yes
No
UPLOAD COPY OF CUSTOMER CONTRACT IF POSSIBLE
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WILL BE REQUIRED TO ISSUE A POLICY
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UPLOAD LOSS HISTORY REPORT/LOSS RUN FROM CURRENT INSURANCE COMPANY IF POSSIBLE
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WILL BE REQUIRED TO ISSUE A POLICY UNLESS YOU ARE A NEW VENTURE
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UPLOAD COPY OF CURRENT POLICY(S) IF POSSIBLE
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