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PEST OFFENSE SURVEY
*Name
Address where Pest Offense® is used:
Mailing Address (if different):
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*Your email address:
Phone:
Number of Adults Living in Household:
Number of Children Living in Household
Do you have any indoor pets?:
Yes
If so, what kind?:
Pest Offense® will be used in:
My Home
My Business
Other
Type of Structure(if applicable):
Select Type
Single Family
Multy-Family
Appartment
Condo
Town Home
Other
Type of Construction (if applicable):
Select Type
Concrete Block
Brick
Wood
Other
Location of Structure:
Select Location
Rural
Suburb
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Approximate Age of Structure:
Condition of structure:
Poor
Good
Excellent
New
How many levels does your structure have?:
Approx. date Pest Offense® was plugged in:
Months
January
February
March
April
May
June
July
August
September
October
November
December
Days
1
2
3
4
5
6
7
8
9
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19
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22
23
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25
26
27
28
29
30
31
2010
2009
2008
2007
2006
2005
2004
2003
How many units was Pest Offense® used in?:
Where did you plug the unit(s) in?:
Type of pest control used before Pest Offense®:
Do you still use another pest control inside along with Pest Offense®?:
Yes
No
If so, what kind?:
What type of Pests did you have?:
Rats
Mice
Roaches
WaterBugs
Ants
Spiders
Silverfish
PalmettoBugs
Earwigs
BoxelderBugs
Bats
Other Types, if applicable:
Frequency of seeing pests before plugging in Pest Offense®:
Select Frequency
Often
Occasionally
Not Very Often
How long after plugging in Pest Offense® did you see results?:
Frequency of seeing pests after plugging in Pest Offense®:
Are you satisfied with the Pest Offense® product?:
Yes
No
Somewhat
Please comment on your experience using the Pest Offense® product:
Would you recommend Pest Offense® to others?:
Yes
No
Possibly
Are you interested in other environmentally friendly products?:
Yes
No
What else can we do to help you reduce the use of toxic chemicals in your life?:
How did you find us?:
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Don Hodgskin: Inventor
with his grandchildren
Littlest Lou and Brittney
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