Customer Information Name: Address: City: State: Zip: Phone: Email: Service Type:SameDifferent
Service Address Name: Address: City: State: Zip: Phone:
Pests Included Pests marked with an asterisk (*) are included in the basic service. You may select additional options for an extra charge.
Target Pests: Ants*Spiders*Rats*Mice*Wasps*Cockroaches*Silverfish*Crickets*Earwigs*Pillbugs*Sowbugs*SnailsBeesFleasCarpet BeetlesFliesGophersStored Product PestsOther
Service Details Service Type:—Please choose an option—MonthlyBi-MonthlyQuarterlyOne-Time
Initial Charge:
Periodic Charge:
Warranty (Months):
Special Instructions:
Desired Service Date
**Regular hours are Mon-Fri 8am to 5pm**
Date:
Time:No Preference8-12 (AM)12-5 (PM)
Month Selection Month Selection:JanFebMarAprMayJunJulAugSepOctNovDec
Card Information: Your card will not be charged until the service is completed. You may also choose to pay in person. This form is to securely vault your payment information in case of nonpayment. You can also sign up for automatic payments (autopay) below.
Name:
Number:
Exp. Month:
Exp. Year:
I would like to sign up for autopay.
Terms & Conditions:
I/We hereby authorize Traffic Pest Solutions to proceed with the selected pest control services. This service agreement covers only the pests specified above and does not include termites, fungi, or other wood-destroying insects. The service is subject to terms and conditions, including rights under the Federal Truth in Lending Law. The agreement is valid for 12 months and can be canceled with 30 days’ written notice. Any discount received for initial service will be charged back if canceled before the contract term. Payment is due upon presentation of the invoice. Thank you!
Legal Confirmation for Electronic Signature I confirm that I intend to sign this document electronically and consent to the use of an electronic signature for this transaction.
Customer Signature:
Traffic Pest Solutions
Phone: (661) 645-6855
Address: 15828 Toscana Ct, Santa Clarita, CA 91387
Website: trafficpestsolutions.com