Residential GPC Agreement
Bug Busters Pest Control
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SERVICE LOCATION (CUSTOMER)
Customer Name
Account #
Street Address
City
State
Zip
Primary Phone
Secondary Phone
Email
Date
BILLING
same as service
Billing Name
Billing Phone
Billing Address
City
State
Zip
Secondary Phone
Billing Email
STRUCTURE
Main Dwelling
Detached Garage
Other
Crawl Space
Basement
Slab
MAINTENANCE PLAN (pick one)
BRONZE
GPC + Rodent
$199 init · $49/mo · $150/qtr
SILVER
GPC + Rodent + 1 Variable
$299 init · $59/mo · $180/qtr
GOLD
GPC + Rodent + T-Vexx
$699 init · $79/mo · $240/qtr
PLATINUM
GPC + Rodent + T-Vexx + Mosquito + Variable
$799 init · $109/mo · $330/qtr
PLAN COVERAGE ADD-ONS ($10/mo each · Mosquito $36/mo)
Green Products
Carpenter Ants
Carpenter Bee
Snake Protection
Flea Protection
Mosquito Service
SERVICE FREQUENCY (pick one)
Monthly
Every Other Month
Quarterly
Tri-Annual
Other
PREFERRED CONTACT
Phone
Text
Email
Keyed Account
METHOD OF PAYMENT
Cash
Check
Credit Card
Commercial Billing
Auto Pay
Check #
Auto-draft day
Special billing
CHARGES
Suggest from plan
Initial Payment
Assessment
Paid
Waived
Amount
Remaining Initial
Follow-up Fee
Additional
Additional $
Recurring
Recurring $
per (Month/Quarter)
First-Year Total
Amount Remitted
NOTES
Special Instructions & Notices
Recommended Work
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