Disinfect & Fog Agent Form - Servcing
Complete the form below, and we will invoice the client.
AGENT Name: *
AGENT Email: *
Client Business name:
Client name: *
Client Email: *
Client Phone number: *
Client Address: *
Client City, Province, Country: *
Client Postal code: *
Type of Business: *
Select one...
Automotive
Business
Child Care
Community Centre
Dental
Education
Entertainment
Funeral Home
Government
Healthcare
Hospitality
Industrial
Place of Worship
Real Estate
Sports + Recreation
Transportation
Tourism
Travel
Veterinarian + Animal Care
Other
If other, enter Below:
Square Footage of space: *
Select one...
0-1999 sq ft
2000-14,999 sq ft
15,000-50,000 sq ft
50,000-100,000 sq ft
100,000+ sq ft
N/A
number of locations: *
COVID-19 positive disinfection:
Select one...
Yes
No
Payment method: *
Select one...
Credit Card
Cheque
E-Transfer
What Service do they want?
Business Fogging
Residential Fogging
Vehicle Fogging
When do they want the service done? *
Pricing discussed with client: *
Additional information (optional):
Thank you!
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