Treatment Report Form

ODIN Pest Control

50 HARRISON STREET, PH487 HOBOKEN NJ 07030
SERVICE DATE

MonthDayYear
Representative Name

First NameLast Name
Client Name

First NameLast Name
Client Address

Street Address

Property Type

CityState

Zip Code
Client Email
Property Type

HouseApartmentOffice
# Bedrooms
Technicians Name
TARGET PEST / VISITY TYPE

Bed BugsAntsRoachesRodentsInspectionInstructional
{technicianComments}TREATMENT MEASURES TAKEN
- Steam disinfection of all beds, mattresses, box springs, chairs, and room perimeter with high temperature low pressure steam application.
- Topical application of insecticides onto baseboards, door frames, window frames, sealing joints, wall joints, underneath floor boards, thoroughly treated bed frames, mattress tufts, box-spring seams, couch seams, chair seams, within the closets, perimeter of room around floorboards, injected into cracks and crevices.
- Drilled 1/8 inch holes to inject aerosolized insecticide mixture via Actisol delivery method for immediate and ongoing control.
- Injected Cymexa dry insecticide for immediate and ongoing control into wall voids via pre-drilled holes, wall outlets, switch plates, cracks and crevices, and underneath floor moldings.
Special Comments

Technicians Special Comments. Please read carefully.
TECHNICIAN INSTRUCTIONS TO CLIENT (SEE COMMENTS & IMAGES BELOW)

Discard MattressDiscard box springDiscard bedding or encasement is damaged.Remove wall to wall carpetIssue coming from adjoining unitMust Pull BaseboardsClient did not prepareClient must de-clutter
Technician Comments / Instructions
{technicianComments}{treatmentInstructions}Post Treatment Instructions:
- Client must vacate apartment for 4 hours after the treatment.
- Encase mattresses and box springs with bed bug proof encasements.
- Install active guard bed liners onto all mattresses within the property.
- Perform thorough disinfection of clothing via laundry of all clothing and running such items through high heat.
IMAGE HERE
IMAGE HERE
IMAGE HERE
IMAGE HERE
IMAGE HERE
IMAGE HERE
IMAGE HERE
IMAGE HERE
IMAGE HERE
IMAGE HERE
IMAGE HERE
IMAGE HERE
TREATMENT INSTRUCTIONS

We have provided you with pre-treatment instructions along with a written copy which include steps to take in order to prepare for your treatment.We have provided you with a written copy of post treatment instructions which include safety precautions and steps to take to make sure the treatment is effective.We have advised you of safety precautions to take after your treatment which include re-entry times and handling of treated items.We have explained to you the treatment measures taken and areas and items treated as well as advised you on safety precautions associated with the treatment.We have advised you that pets, children, asthmatic individuals, or induviduals with chronic illness or otherwise sensitive individuals need to vacate the premises and that special precautions must be taken after the treatment.We have provided you with contact information for our office staff.We have provided you with instructions on how to schedule your follow up treatment.We have advised you of the importance of adhering to schedule of follow up treatments. Missed treatments may result in voiding your warranty and ineffectiveness of treatments.You acknowledge that you are responsible for your property and treatment and our presence at your property and the extermination is a direct result of you hiring us.We have advised you of your post treatment responsibilities and provided you with a written copy of those instructions.We have identified any specific items that may need to be discarded and or removed from the property.You acknowledge your responsibility for the safekeeping of personal items and valuables.You acknowledge that no personal items are missing or damaged upon completion of the service visit.Other
Additional Comments / Instructions.
Terms & Conditions

ODIN Pest Management has provided above named customer with pest control services. By signing below the customer acknowledges that on the above date our technicians have performed all related services and agree to accept such services as completed. Customer acknowledges their responsibility to pay for said services. Customer acknowledges that any future services under this invoice are ancillary and payment is not contingent on performance of such future services. Customer acknowledges that fees for services are due immediately and are nonrefundable. Customer acknowledges that they had a chance to review such terms and conditions prior to inception of services and. By signing below customer acknowledges that they have read and understood these terms and conditions.
CLIENT ACKNOWLEDGMENT SIGNATURE - *

Clear
CLIENT NAME AND SIGNATURE
Should be Empty:

ODIN Pest Control

Special Comments