Servng Nassau and Suffolk Counties
Long Island, New York

SCHEDULE A SERVICE

Use this form to request a service visit, or to request setup of a Certified Termite and Pest Management Service agreement (monthly, quarterly, annually). If you need a pest or termite INSPECTION, please use this form to request this FREE service.

For immediate assistance, please call
(631) 696-1075

( * = Required Information)
Choose which type of service you need:

 
*Last Name:
*First Name:
*Street Address:
*E-mail address:
*City:
*State:
*Zip:
*Home Phone:
Work Phone:
Type of Pest:
Where do you see them most?
Do you see pests during the day, night or both?
*How many bedrooms does your home have?
*Do you have a basement?
Yes     No
*How many bathrooms does your home have?

Check this box if you have been a Certified customer before.
    
*Certified Services require your execution of an Annual Pest Control Service Agreement and Certified acceptance of that agreement. All services are subject to the terms, limitations and conditions contained within that Agreement.
Certified considers the information you share with us as personal and confidential. We will not sell or share this information with anyone other than an employee, agent or representative of Certified Pest Management.

 

Licensed - Certified - Insured

24 hours / 7 Days a Week Service
TEL/FAX: (631) 696-1075

Copyright ©2001-2013 - Certified Pest Management
Eugene Karwoski, Jr. - EPA #C1630594
Coram, New York