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Pests & Termites'
4001 Virginia Avenue,Fort Pierce;FL 34981
ro 772-429-7716•www.wipeoUtpests.com
NOTICE OF
Inspection ;:Treat `t
Date Treatment �—
Reason/Organism
Inspection Treatment
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Date Treatment,
Reason/'Organism :u
Inspection Treatment.
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Date Treatment
Reason/Organism
Inspection Treatment
Date Treatment';
Reason/Organism .
Inspection Treatment
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Date Treatment
Reason/Organism
APPT.DATd I dok TIME
INSPECTOR TECH EN W M" DATE TAKEN: BY:
MN ■ ■ � � � ■
Services, LLC
Martin 772-287-8486•St.Lucie 772429-7716
Indian River 772-567-7392 • Palm Beach 561-746-7364
Corporate Office
4001 Virginia Avenue,Suite A•Fort Pierce,Florida 34981
FOR FAST,PROFESSIONAL SERVICE CALL
CUSTOMER INFORMATION Acct. # SERVICE REOUESTED
\20 _3 U? M\�O ple
NAME
ADDRESS SOURCE
lGyl% FL �
CITiv STATE ZIP CODE/GRID '
� 5 CONTRACTS:
HOME TEL# WORK Tr=L#
DIRECTIONS
PAYMENT/CREDIT CARD INFORMATION AUTHORIZATION
SVC AM CA TYPE CHECK#/CARD /Ef P DATE AMT CODE DATE TIME
2.
4.
TOTAL DUE TOTAL AUTH. DEFERRED DATE
CARDHOLDER NAME(If different from above)
I AGREE TO PAY ABOVE TOTALAMOUNT ACCORDING TO CARD ISSUER AGREEMENT(Visa/MasterCard Customer Inquiries Call 1-800-920-1079).
SIGNATURE: DATE:
VALUED CUSTOMER COMMENTS:
SALES TECH COMMENTS: l D 0 00
PEST CONTROL/FLEAS/OTS TERMITE/FUME
MATERIAL INSPECTED Evidence Treated MATERIAL
TREATMENT SITES TREATED Name(%)&Amt SITES l(Y/N) (Y/N) Name(%)&Amount
Mulch/Flowerbeds Foundation /" cj oN.0
Woodpile/Garbage Area Crawl Space 4
Doors/Windows/Eaves Interior Walls
Attic/Crawl Space Door Frames
Underneath Appliances Window Frames
Wall Voids/False Bottoms Bath Traps
Cracks/Crevices Attic
Drawers/Cabinets/Closets Other
Other A IW
�1
TARGET PESTS Time/Beg: Comp: • / TOT:
Endorse ent hereon acknowledges receipt of and satisfaction for services rerldered. I i the above t be true and an a c rate re of my operations.
CUSTOMERS SIGNATURE DATE WIPEO T CIAN