Zavagn 440-884-2530, Pavarini 216-374-4500

Pest Control Business Insurance

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.

Company Information

Company Name *

Street *

City *

State *

ZIP / Postal Code *

Primary Phone Number *

Alternate Phone Number

E-Mail Address *

Business Type

Company Owner

First Name *

Last Name *

Gross Annual Sales

Square Footage of Location

How long in business? *

How many years experience in this field? *

Trade Organization Membership

Prior Insurance

Length of Coverage (Months and Years)

Expiration Date

Number of Additional Insureds Needed

Describe any claims, lawsuits, administrative actions

Number of Owners

“Employees” include: Sole proprietor, Partner, Executive Officers, Seasonal employees, Part-time employees, Full-time employees.

Number of Full Time Employees *

Number of Part Time Employees

Annual Employee Payroll

Please explain pre-employment screening requirements *

Subcontractors Used

Annual Cost of Subcontractors

What state(s) do you offer products or services? *

What percentage of your services are provided at:

Commercial, Industrial or Institutional Locations *

Food Service, Restaurant, Kitchen Locations *

Residential Homes and Apartments *

How many WDI inspections are conducted each year? *

Describe any aerial, drone, crop spraying, tenting services offered *

Describe treatment of private ponds, lakes, streams, or other bodies of water?

Describe bedbug treatments, heat treatments

List main chemicals used for treatment

Attach your customer service agreement

Do you need pricing on commercial auto, buildings, business property? *

Do you need pricing on a surety bond? *

How did you hear about us?

Full Name of Person Entering Application *

Submission Validation

Required

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.

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Zavagno 440-884-2530 and Pavarini 216-374-4500