Fumigation Request


Cubes:
Requested Fume Date:
ReEntry Date:
Termite Company:
Contact Person:
Contact Email:
Contact Number:
Emergency Number:
Owner's Name:
Realtor:
Address:
City/Zip:
Target Pest:
MapPage:
Property is: Furnished/Occupied
Furnished/Unoccupied
Vacant
Electricity: On
Off
Foundation: Concrete Slab
Raised
Other
Other Comment:
Building: 1 Story House
2 Story House
3 Story House
Apt Building
Condo
Duplex
Mobile Home
Other structure attached or close enough to require fumigation
Other Comment:
Garage: Attached
Detached/Fume
Detached/No Fume
Attached Carport
Detached Carport/Fume
Detached Carport/No Fume
Attached Patio
Other
Other Comment:
Roofing: Composition
Composition/Rock
Concrete Shingles
Metal Shingles (Roof Release Required)
Tile (Roof Release Required)
Roof Insurance *Additional Charge
Wood Shingles
Other
Other Comment:
Forms Information: Fax
On Property
Will Admit w/ Forms
Meter Box
Kitchen Counter
Other
Other Comment:
Key Information: Master Key
Meter Box
Lock Box Combo *SEE BELOW
Under the Mat
Will Admit
Other
Other Comment:
*Lock Box Combo Is:
Special Conditions: Steep Roof
Zero Lot Line (Neighbor Release Required)
Vegetation (Plant Release Required)
Other
Other Comment:
Rooms with Inoperable Window(s):
Sales Inspector:
Phone Number:
Gas Meter Location:
* Make sure all gates are unlocked
Special Request(s): AM Fume
PM Fume
AM Certification
Tape and Seal
Other
Any Other Comments:
You must receive a job number from us in order to confirm your request.

Copyright 2018 - Southwood Pest Control
1505 Harmony Circle, Anaheim, CA, 92807 - Ph. 1-800-780-7773
Some restrictions apply. Call for details. License # PR 846