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Disinfection Service
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Flies
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Bookings
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Personal Details
Full name*
Surname*
Email*
Site Address*
Town/Suburb*
Phone No.*
Booking Details
Are you a previous customer of Fly Co - The Green Pesty?*
yes
no
Please select are you a previous customer
Are you booking or enquiring?*
Booking
Enquiry
Please select are you booking or enquiring
How Did you find out about FlyCo?*
Please Select
Google
Friend / family
Facebook
Please select how did you find about FlyCo
Areas to be treated*
Inside
Outside
Shedding
Same as last time
Other
Please select areas to be treated
Pests to be treated*
Flies
Spiders
Mozzies
Cockroaches
Ants
Rodents
Disinfection Service
Please select Pests to be treated
Preferred treatment month?*
January
February
March
April
May
June
July
August
September
October
November
December
Please select preferred treatment month
Preferred time of month?*
Early
Mid
Late
Please select time of month
Preferred payment method?*
Cash
Cheque
Credit Card
Direct Debit
Please select preferred payment method
Register for treatment reminders?
SMS
Phone
Letter
Email
Has anyone in this house recently returned from overseas?
Please Select
Yes
No
Please select Yes/No
Is anyone in this house currently experiencing any flu like or respiratory symptoms such as fever, cough, shortness of breath?
Please Select
Yes
No
Please select Yes/No
Has anyone in this premise had contact with someone who has been diagnosed with COVID-19?
Please Select
Yes
No
Please select Yes/No
Do you have COVID-19 or are you in a period of 14 days isolation?
Please Select
Yes
No
Please select Yes/No
Have you had COIVD -19 Test in the last 14 days.
Please Select
Yes
No
still awaiting results
results were negative
results were positive
Other Notes
Affiliated Sponsorship Name / Number
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