GPC Service Report Form
Merchant/ Unit #
Building
PMS
Time in
Hour Minutes
AM
PM
AM/PM Option
Time out
Hour Minutes
AM
PM
AM/PM Option
Noted by:
Date
-
Month
-
Day
Year
Date
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Level of infestation
High
Med
Low
# of sighting
Species
Location
Cockroaches
1
2
3
Mosquitoes
4
5
6
Flies
7
8
9
Mice
10
11
12
Others
13
14
15
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Action taken
Location
Pest-A-Spray
Pest-A-Mist
Pest-A-Fog
Pest-A-Bait
Rat-Away
Others
Location 1
16
17
18
19
Location 2
20
21
22
23
Location 3
24
25
26
27
Location 4
28
29
30
31
Location 5
32
33
34
35
Location 6
36
37
38
39
Location 7
40
41
42
43
Location 8
44
45
46
47
Location 9
48
49
50
51
Location 10
52
53
54
55
Location 11
56
57
58
59
Location 12
60
61
62
63
Location 13
64
65
66
67
Location 14
68
69
70
71
Location 15
72
73
74
75
Location 16
76
77
78
79
Location 17
80
81
82
83
Location 18
84
85
86
87
Location 19
88
89
90
91
Location 20
92
93
94
95
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Remarks:
Recommendations:
96
Satisfied
Not Satisfied
Comments
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Payment Option
Customer's Name
Customer's Signature
Date
-
Month
-
Day
Year
Date
Submit
Should be Empty: