::Pest Offense Survey::

PEST OFFENSE SURVEY

Name:

Address where Pest Offense® is used:

City: State: Zip:

Mailing address (if different):

City: State: Zip:

Email address:

Phone:

Number in household Adults:

Children:

Do you have any indoor pets?:

Yes No If so, what kind?:

Pest Offense® will be used in:

My home My business Other

Type of Structure (if applicable):

Type of Construction (if applicable):

Location of Structure:

Approximate Age of Structure:

Condition of structure:

Poor Good Excellent New

How many levels does your structure have?:

Approx. date Pest Offense® was plugged in:

How many units was Pest Offense® used in?:

Where did you plug the unit(s) in?:

Type of pest control used before Pest Offense®:

Do you still use another pest control inside along with Pest Offense®?:

Yes No If so, what kind?:

What type of Pests did you have?:

Frequency of seeing pests before plugging in Pest Offense®:

How long after plugging in Pest Offense® did you see results?:

Frequency of seeing pests after plugging in Pest Offense®:

Are you satisfied with the Pest Offense® product?:

Yes No Somewhat

Please comment on your experience using the Pest Offense® product:

Would you recommend Pest Offense® to others?:

Yes No Possibly

Are you interested in other environmentally friendly products?:

Yes No

What else can we do to help you reduce the use of toxic chemicals in your life?:

How did you find us?: