Customer Information
Client Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Acknowledgment & Agreement
By submitting this form, I acknowledge and agree to allow Weedex Lawn Care to apply a non-selective herbicide for the elimination of difficult-to-manage grassy weeds. I understand that this treatment will kill all vegetation in the treated area, including turfgrass, and may impact surrounding landscaping. I accept full responsibility for any necessary lawn restoration and release Weedex from liability for any unintended effects beyond their control.
Customer Acknowledgment
By checking the boxes below, I confirm that I understand and agree to the following:
Property Verification
*
I confirm that the service address provided on this waiver is correct and matches the property scheduled for treatment. If the address on this waiver does not match the address on my Weedex account, I understand that Weedex will not proceed with treatment, this waiver will be declined, and my service may be delayed until the correct waiver is submitted.
Use of Non-Selective Herbicide
*
I understand that Weedex will apply a non-selective herbicide (such as Round-Up) to eliminate specific grassy weeds, including but not limited to dallisgrass, King Ranch bluestem, bahiagrass, carpetgrass, and johnsongrass.
Damage to Turfgrass
*
I acknowledge that this treatment will result in the complete death of the treated turfgrass and that surrounding vegetation may also be affected due to product drift, soil leaching, or other environmental factors.
No Guarantee of Full Weed Elimination
*
I understand that while this treatment is designed to target specific grassy weeds, complete eradication is not guaranteed and multiple applications may be required.
Customer Responsibility for Lawn Repairs
*
I accept full responsibility for any necessary lawn restoration, which may include removing treated areas, replacing soil and sod, or allowing the lawn to naturally recover over multiple seasons. I acknowledge that Weedex is not responsible for replanting, reseeding, or repairing any treated areas.
Release of Liability
*
I hereby release Weedex Lawn Care, its employees, and representatives from any and all claims, damages, or liabilities resulting from the application of non-selective herbicides, including but not limited to damage to surrounding vegetation, soil conditions, or any unintended effects beyond Weedex’s control.
Final Acknowledgment & Signature
I affirm that the information provided in this waiver is accurate, and I agree to all terms outlined above. My signature below signifies my understanding and agreement.
Client Signature
*
Date
*
-
Month
-
Day
Year
Submit
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