Termite Work Order Date Owner Name Street Address City Zip Phone Email Billed To (if different from above) Name Street Address City Zip Phone Email Structure Structure Main Building Other Other Services Needed Services Needed Termite Powder Post Beetles Old House Borers Other Other Chemical Chemical Centerfire .05% Termidor .06% Bora Care 16% None Other Other Type of Treatment Type of Treatment Exterior Only Exterior & Piers Complete In & Out Other Other Need Waiver Need Waiver Yes No None Total Cost Annual Renewal Date Completed Completed By Authorized Representative Customer Signature (type name below) SUBMIT We're Proud Memebers of... Address 2701 Commerce RdJacksonville, NC 28546 Contact 910-455-5888