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APPIDATE lO~-'dD-D7T1ME ~d,'DtJ WIPEOUT ~
SLSMAN: TECH Pests & Termites DATE TAKEN: (O·~~~:at sr
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St. Lucie: 772-429-7716 · Martin: 772-287-8486 · Indian River: 772-567-739'2 · JÜpiter: 56<","7,...46-7364
5203 Okeechobee Road ':" , ,> .' "};p;.:\~\
Fort Pierce, Florida 34947 MAILING ADDRESS ""'(,: v~. "'j
P.O. Box 1766 'Cc;., i... ·"'-t>
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Fort Pierce, FL 34954-1766 (,'Ji~
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FOR FAST, PROFESSIONAL SERVICE CALL
CUSTOMER INFORMATION Acct. #
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NAME
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FL
SERVICE REQUESTED
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HOME TEL II
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STATE
WORK TEL II
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DIRECTIONS
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PAYMENT / CREDIT CARD INFO 10
AMT. CARD TYPE C \ CJSJ!-...-. RD øDA. :IE
} ;:),5 · Oü <.Ï~ 6e/ A . 60X
AMT
AUTHORIZATION
CODE DATE
TIME
2.
3.
4.
TOTAL DUE TOTAL AUTH. DEFERRED DATE
CARDHOLDER NAME (If different from above)
I AGR~E TO PAY ABOVE TOTAL AMOUNT ACCORDING TO CARD ISSUER AGREEMENT (Visa/MasterCard Customer Inquiries Call 1-800-920-1079).
SIGNATURE:
DATE:
VALUED CUSTOMER COMMENTS:
PEST CONTROL / FLEAS / OTS
SALES TECH COMMENTS:
TREATMENT SITES
TREATED
MATERIAL
Name (%) & Amt
TERMITE / FUME
INSPECTED Evidence Treated
SITES (Y/N) (V/N)
Foundation
Crawl Space
I nterior Walls
Door Frames
Window Frames
Bath Traps
Attic I
Other
Mulch/Flowerbeds
Woodpile/Garbage Area
Doors/Wi ndows/Eaves
Attic/Crawl Space
Underneath Appliances
Wall Voids/False Bottoms
Cracks/Crevices
Drawers/Cabinets/Closets
Other
TARGET.~
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