Service Address
ORKIN Service Areas
Washington State
Utah
Idaho
Oregon
Washington Areas
(North Western) Seattle Downtown, WA Area
(North Western) Everett/Bellingham, WA Area
(North Western) Kent/Tacoma, WA Area
(Central Western) Olympia, WA Area
(Central) Yakima/Ellensburg/Kennewick
(Southern Western) Vancouver, WA Area
(North Eastern) Spokane, Area
Oregon Areas
(North) Portland Downtown, OR Area
(Western) Eugene, OR Area
(South Western) Medford, OR Area
(Coastal) Newport, OR Area
(Central) Bend, OR Area
(North Central) The Dalles, OR Area
(Eastern) Baker City/La Grande/ Ontario, OR Area
Idaho Areas
(South West) Boise, ID Area
(Southern Idaho) Twin Falls, ID Area
(South Eastern) Pocatello, ID Area
(Eastern Idaho) Idaho Falls/Island Park, ID Area
(Eastern Central Idaho) McCall/Cascade ID Area
(Central Idaho) Sun Valley/Stanley, ID Area
(Northern Idaho) Lewiston/Coeur d' Alene, ID Area
Utah Areas
(Northern Utah) Logan/Tremonton, UT Area
(SLC, North) Ogden, UT Area
(SLC Central) SLC,UT Area
(SLC South) Provo, UT Area
(Central Utah) Fillmore/Salina, UT Area
(Southern Utah) St George/Moab, UT Area
ORKIN Rep's Name
ORKIN Rep's Email
ORKIN Branch Number
ORKIN Rep's Phone
Single or Multi Unit?
Single Unit
Multi Unit
Client Address
Number of Units (max 4/entry) Must check all that apply
2nd Unit
3rd Unit
4th Unit
Unit 1 #
Property 2 Unit #
Property 3 Unit #
Property 4 Unit #
Property Location Picture(s)
1st Property File Upload
Picture Main Area
Add files
Drop files here to add
2nd Property File Upload
Picture Main Area
Add files
Drop files here to add
3rd Property File Upload
Picture Main Area
Add files
Drop files here to add
4th Property File Upload
Picture Main Area
Add files
Drop files here to add
1st Property Square Footage
What is the total square footage of the property?
2nd Property Square Footage
What is the total square footage of the property?
3rd Property Square Footage
What is the total square footage of the property?
4th Property Square Footage
What is the total square footage of the property?
1st Property # of Previous Treatments
x
0 (Property Never Treated)
1
2
3
4
5
More
2nd Property # of Previous Treatments
x
0 (Property Never Treated)
1
2
3
4
5
More
3rd Property # of Previous Treatments
x
0 (Property Never Treated)
1
2
3
4
5
More
4th Property # of Previous Treatments
x
0 (Property Never Treated)
1
2
3
4
5
More
1st Property Vacant or Occupied
x
Vacant
Occupied
2nd Property Vacant or Occupied
x
Vacant
Occupied
3rd Property Vacant or Occupied
x
Vacant
Occupied
4th Property Vacant or Occupied
x
Vacant
Occupied
1st Property - How Long has the property been vacant
2nd Property - How Long has the property been vacant
3rd Property - How Long has the property been vacant
4th Property - How Long has the property been vacant
1st Property - Activity
x
(Population Density)
1 week - 1 month
1 month - 3 months
3 months - 6 months
6 months - 1 year
Over a year
2nd Property - Activity
x
(Population Density)
1 week - 1 month
1 month - 3 months
3 months - 6 months
6 months - 1 year
Over a year
3rd Property - Activity
x
(Population Density)
1 week - 1 month
1 month - 3 months
3 months - 6 months
6 months - 1 year
Over a year
4th Property - Activity
x
(Population Density)
1 week - 1 month
1 month - 3 months
3 months - 6 months
6 months - 1 year
Over a year
Property - Structure Type
x
Which structure type matches closest to the property?
House
Apartment
Condo
Duplex/Triplex
Hotel/Motel
Care Facility
Mobile/Manufactured
Commercial Building
Other:
1st Property - # of Bed Rooms
2nd Property - # of Bed Rooms
3rd Property - # of Bed Rooms
4th Property - # of Bed Rooms
Property - Site Construction
x
What is the site construction type?
Standard (Timber, Sheet Rock)
Cinder Block or Concrete
Steel
Log Home
Mobile W/ foundation
Mobile W/O foundation
Manufactured W/ foundation
Manufactured W/O foundation
Other:
1st Property - Space Contents
x
(Clutter Levels)
LVL 1-Average contents for the size of the space
LVL 2-Above average contents for the size of the space
LVL 3-Excessive contents for the size of space
LVL 4-Extreme contents for the size of space
2nd Property - Space Contents
x
(Clutter Levels)
LVL 1-Average contents for the size of the space
LVL 2-Above average contents for the size of the space
LVL 3-Excessive contents for the size of space
LVL 4-Extreme contents for the size of space
3rd Property - Space Contents
x
(Clutter Levels)
LVL 1-Average contents for the size of the space
LVL 2-Above average contents for the size of the space
LVL 3-Excessive contents for the size of space
LVL 4-Extreme contents for the size of space
4th Property - Space Contents
x
(Clutter Levels)
LVL 1-Average contents for the size of the space
LVL 2-Above average contents for the size of the space
LVL 3-Excessive contents for the size of space
LVL 4-Extreme contents for the size of space
Property - Basement
x
Does the structure have a Basement
No
Yes
1st Property - Pets
Select all that apply
None
Mammals
Reptiles
Birds
Aquatic
Other:
2nd Property - Pets
Select all that apply
None
Mammals
Reptiles
Birds
Aquatic
Other:
3rd Property - Pets
Select all that apply
None
Mammals
Reptiles
Birds
Aquatic
Other:
4th Property - Pets
Select all that apply
None
Mammals
Reptiles
Birds
Aquatic
Other:
1st Property - Mammals
Example: Dogs, Cats
2nd Property - Mammals
Example: Dogs, Cats
3rd Property - Mammals
Example: Dogs, Cats
4th Property - Mammals
Example: Dogs, Cats
1st Property - Reptile
Example: Snake, Lizard
2nd Property - Reptile
Example: Snake, Lizard
3rd Property - Reptile
Example: Snake, Lizard
4th Property - Reptile
Example: Snake, Lizard
1st Property - Birds
Example: Parrot, Budgie
2nd Property - Birds
Example: Parrot, Budgie
3rd Property - Birds
Example: Parrot, Budgie
4th Property - Birds
Example: Parrot, Budgie
1st Property - Aquatic
Example: Goldfish, Koi
2nd Property - Aquatic
Example: Goldfish, Koi
3rd Property - Aquatic
Example: Goldfish, Koi
4th Property - Aquatic
Example: Goldfish, Koi
1st Property - Street Level Entrance
No
Yes
1st Property - What floor is the property on?
2nd Property - What floor is the property on?
3rd Property - What floor is the property on?
4th Property - What floor is the property on?
Elevator Avaliable
No
Yes
Uncovered Parking Avaliable
x
No
Yes
Types of Parking Avaliable
Select all that apply
Street Parking
Metered Parking
Driveway
Alleyway
Other:
Parking Distance
<100 ft
100 - 200 ft
200 - 300 ft
300 - 400 ft
400 - 500 ft
500 - 600 ft
>600 ft
Other:
1st Property - Fire Suppression
Does the property have a fire suppression or heat sensor system?
No
Yes
2nd Property - Fire Suppression
Does the property have a fire suppression or heat sensor system?
No
Yes
3rd Property - Fire Suppression
Does the property have a fire suppression or heat sensor system?
No
Yes
4th Property - Fire Suppression
Does the property have a fire suppression or heat sensor system?
No
Yes
1st Property - Fire Protect
Select all that apply
Sprinklers
Heat Sensors
Other:
2nd Property - Fire Protect
Select all that apply
Sprinklers
Heat Sensors
Other:
3rd Property - Fire Protect
Select all that apply
Sprinklers
Heat Sensors
Other:
4th Property - Fire Protect
Select all that apply
Sprinklers
Heat Sensors
Other:
1st Property - Number of Sprinkler Heads
2nd Property - Number of Sprinkler Heads
3rd Property - Number of Sprinkler Heads
4th Property - Number of Sprinkler Heads
1st Property - Number of Heat Sensors
2nd Property - Number of Heat Sensors
3rd Property - Number of Heat Sensors
4th Property - Number of Heat Sensors
10
1st Property - Plants
No Plants
Average plants for the size of the space
Above average plants for the size of the space
Excessive plants for the size of space
Other:
10
2nd Property - Plants
No Plants
Average plants for the size of the space
Above average plants for the size of the space
Excessive plants for the size of space
Other:
10
3rd Property - Plants
No Plants
Average plants for the size of the space
Above average plants for the size of the space
Excessive plants for the size of space
Other:
10
4th Property - Plants
No Plants
Average plants for the size of the space
Above average plants for the size of the space
Excessive plants for the size of space
Other:
10
1st Property - Heat Sensitive Materials
Select all that apply
No Heat Sensitive Materials
Vinyl Blinds
Vinyl Records
VCR Tapes
Make-Up (Wax based Lipstick)
Waxes (Crayons, Candles)
Aerosol Cans
Perishable Food & Drink
Musical Instruments
Other:
10
2nd Property - Heat Sensitive Materials
Select all that apply
No Heat Sensitive Materials
Vinyl Blinds
Vinyl Records
VCR Tapes
Make-Up (Wax based Lipstick)
Waxes (Crayons, Candles)
Aerosol Cans
Perishable Food & Drink
Musical Instruments
Other:
10
3rd Property - Heat Sensitive Materials
Select all that apply
No Heat Sensitive Materials
Vinyl Blinds
Vinyl Records
VCR Tapes
Make-Up (Wax based Lipstick)
Waxes (Crayons, Candles)
Aerosol Cans
Perishable Food & Drink
Musical Instruments
Other:
10
4th Property - Heat Sensitive Materials
Select all that apply
No Heat Sensitive Materials
Vinyl Blinds
Vinyl Records
VCR Tapes
Make-Up (Wax based Lipstick)
Waxes (Crayons, Candles)
Aerosol Cans
Perishable Food & Drink
Musical Instruments
Other:
1st Property - Property Contact's First Name
2nd Property - Property Contact's First Name
3rd Property - Property Contact's First Name
4th Property - Property Contact's First Name
Property Emergency Phone
Notes On Service
1st Choice Service Date
2nd Choice Service Date
Submit To Custom Bedbug
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