Pest Control Client Form
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1
CUSTOMER SERVICE
2
CLIENT DETAILS
3
SERVICES
4
COST OF SERVICES
5
PAYMENT DETAILS
6
ON-SITE REPORT
7
FEEDBACK
8
ENTRY PREVIEW
Customer Rep in Charge
First
Last
Attended to Client Via:
Phone Call
WhatsApp
Instagram
Email
Tiktok
Others
Specify Others
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Client / Company Name
Filled Estimate Form?
Select
Yes
No
Date Client Reached Out
Email
Email
Confirm Email
Client's Phone
Client's WhatsApp / Other Line
Location
Select
Abuja
Lagos
Kano
Rivers
Abia
Adamawa
Akwa Ibom
Anambra
Bauchi
Bayelsa
Benue
Borno
Cross River
Delta
Ebonyi
Edo
Ekiti
Enugu
Gombe
Imo
Jigawa
Kaduna
Kastina
Kebbi
Kogi
Kwara
Nasarawa
Niger
Ogun
Ondo
Osun
Oyo
Plateau
Sokoto
Taraba
Yobe
Zamfara
Address
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Service
*
PEST CONTROL
PEST CONTROL & PFC
PFC
DISINFECTION
RE-FUMIGATION
Property Type
Select
Residential
Commercial
Full Description of Property
Target Pest(s)
Mosquitoes -
Cockroaches -
Rats/Mice -
Bedbugs -
Snakes -
Scorpions -
Wall Geckos -
Termites -
Ants -
Ticks -
Spiders -
Others
Other Target Pest(s)
Service Date
Time
Service Note
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Invoice Number
Pest Control Service Charge
PFC Service Charge
Disinfection Service Charge
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Mode of Payment
CASH
TRANSFER
CHEQUE
Bank
ZENITH BANK (1015359804)
GTBANK (0657569467)
GTBANK MOVING (0604576254)
FCMB (2000029134)
PROVIDUS (5401801140)
Payment
Select
FULL UPFRONT PAYMENT
PART UPFRONT PAYMENT
FULL PAYMENT ON SITE
PART PAYMENT ON SITE
FULL PAYMENT AFTER SERVICE
Full Amount Paid
Upfront Paid
Balance Paid
Transaction Date
Balance Transaction Date
Receipt Number/Referral Code
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Supervisor's Name
First
Last
Name(s) of Other Technicians
Time of Arrival
Arrived Late?
Select
Early
Late
Give Reason(s) For Arriving Late
Name of Contact Person
Contact Person's Phone
Who Signed Consent Form?
Last Fumigation Date
Last Fumigation Target Pest(s)
Next Due Date
Client's Contribution/Concern
On-Site Challenges/Limitations
Pesticides and Quantity Used
Other Materials and Quantity Used
Machine Used
Thermal Fogger
Ultra Low Volume Fogger (ULV)
Stihl Mist Blower
Motorized Sprayer
Gloria Pressure Sprayer
Others
Others
Activity Summary
Supervisor's Comment
On-site Recommendation(s)
Office Recommendation(s)
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Feedback Status
Select
Very Satisfied
Satisfied
Indifferent
Not Satisfied
Reasons For Not Being Satisfied
Conduct
Punctuality
Conc. of Chemicals
Target Pest(s)
Untreated Area(s)
PFC
Experience with Customer Rep:
Experience with Exterminators:
Punctuality:
Personal Protective Equipment (PPE):
Post Fumigation Cleaning (PFC):
Extra Charge For Service:
Treatment of Specified Areas
Rating From Clients
Rate 1 out of 10
Rate 2 out of 10
Rate 3 out of 10
Rate 4 out of 10
Rate 5 out of 10
Rate 6 out of 10
Rate 7 out of 10
Rate 8 out of 10
Rate 9 out of 10
Rate 10 out of 10
Client's Suggestion(s)
Other Feedbacks
How The Client Found Us
Select
Instagram
Google
TikTok
Website
Family & Friends
Vehicle Ad
Others
Specify Others
Name of Feedback Manager
First
Last
Who called the client?
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