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Pest Control Questionnaire


Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

General Information
Company Name
Required
Street
Required
City
Required
State
Required
ZIP / Postal Code
Required
First Name
Required
Last Name
Required
Primary Phone Number
Required
Fax Number
Optional
E-Mail Address
Required
Best Way to Contact You
Optional



Tell Us About Your Business
Business Type
Optional




How long have you been in business?
Optional
This business is
Optional

Do you conduct operations outside of Michigan?
Required

Business is conducted from
Optional

Percentage of work that is residential
Optional
Percentage of work that is commercial
Optional
Number of Owners
Required
Number of Employees OTHER than Owners
Required
Estimated Annual Payroll (Excluding Owners)
Required
Annual Cost of Subcontractors
Optional
Gross Annual Sales
Optional
Estimated number of WDI / WDO inspections per year
Optional
License Number
Optional
List Categories You are Licensed For
Optional
What percentage of your gross sales comes from each of the following services?
% From General Pest Control
Optional
% From Termite Control
Optional
% From Fumigation
Optional
% From Nuisance Animal Control
Optional
% From Lawn Care Services
Optional
% From Tree Care Services
Optional
% From WDI / WDO Inspections
Optional
% From Crop Spraying Operations
Optional
% From Mold Inspections
Optional
Are MSDS sheets provided to each customer?
Required
How many gallons of pesticides are on hand at one time?
Required
How are excess pesticides disposed of?
Required
How and where are pesticides stored?
Required
Are all technicians licensed or certified?
Required
Are regular safety meetings conducted with employees?
Required
Are there retail sales of any products?
Required
If yes, give annual gross sales and description of products sold
Optional
Liability Insurance
Current Insurance Company
Required
Policy Number
Optional
Current Liability Limits / Deductible?
Optional
Current Premium
Optional
Expiration Date
Optional
/ /
Describe any claims in the past 3 years
Required
What coverage limits do you want quoted?
Optional



How many additional insureds are required?
Optional
Commercial Auto
Our auto insurance INCLUDES pollution coverage for pesticides. Complete the Commercial Auto questionnaire for a quote.
Bonds
Business Services Bond (Protects your customers against theft by your employees)
Required
Employee Dishonesty (Protects your business against theft by employees)
Required
Workers Compensation
Current Insurance Company
Required
Policy Number
Optional
Current Premium
Optional
Expiration Date
Optional
/ /
FEIN or Social Security if Sole Proprietorship
Optional
Property Insurance
Describe any property or list any equipment you wish to insure, along with their values
Required
How did you hear about us?
Required
Comments or additional information about your business?
Optional
Submission Validation
Required
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Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages.  Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company.  If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.
HAPPY 4th of JULY!

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Lighthouse Group Main Office in Grand Rapids, MI
Mailing Address | P.O. Box 530009, Livonia, MI 48153

Phone: 734.421.9900 | Toll Free: 800.220.5582 | Fax: 734.421.9911

Also serving these Detroit area communities in Michigan: Livonia, Farmington Hills, Ann Arbor, Southfield, Plymouth, Canton, Westland, Northville, Novi, Dearborn, South Lyon & Walled Lake