Welcome New Client Form To begin, please fill out the form below. OWNER INFORMATION Owner Name * First Name Last Name Owner Email * Owner Phone * Country (###) ### #### HOUSE OR BUSINESS INFORMATION Home or Business Name * Home or Business Location * Access Codes (gated entry) Business Operating Days & Hours (if applicable) PROPERTY MANAGER & GARDENER INFORMATION Property Management Company (if applicable) Property Manager Contact Name First Name Last Name Property Manager Contact Phone Country (###) ### #### Gardener Name Gardener Phone Country (###) ### #### FACTURA ELECTRONICA INFORMATION Company Name Cedula or ID # Address Phone Country (###) ### #### Email MOSQUITO SERVICES Which payment term do you prefer? * 3 months 6 months 12 months Please read the terms of service: Limits of Liability Although EcoMosquito will exercise reasonable care in performing services under this Agreement, EcoMosquito will not be liable for injuries or damage to persons, property, animals, or vegetation, except those damages resulting from gross negligence by EcoMosquito. Further, under no circumstances will EcoMosquito be responsible for any injury, disease, or illness caused, or allegedly caused, by bites, stings, or contamination by insects or pests. EcoMosquito representatives are not medically trained to diagnose insect or pest-borne illnesses or diseases. Please consult your physician for any medical diagnosis. To the fullest extent permitted by law, EcoMosquito will not be liable for personal injury, death, property damage, loss of use, loss of income, or any other damages whatsoever, including consequential and incidental damages, arising from this service. EcoMosquito's liability is specifically limited to the labor and products necessary to help target pest infestations. Severability If any part of this Agreement is held to be invalid or unenforceable for any reason, the remaining terms and conditions of this Agreement will remain in full force and effect. General Conditions NOTICE OF CLAIMS, AND ACCESS TO PROPERTY. Any claim for breach of this agreement will be made immediately in writing to any EcoMosquito. EcoMosquito is only obligated to perform under this agreement provided the Purchaser allows EcoMosquito access to the property for any purpose contemplated by this agreement, including but not limited to inspection. EcoMosquito agrees to provide services at the address indicated above to control the issues checked above. The Customer agrees to make the place of service available for treatment and/or inspection as often as necessary to control the issues checked above. This contract does not provide for the repair of present or future damages to the service address, nor does it provide reimbursement for repair expenses allegedly arising from pest infestations. In entering into this contract, the Customer waives all claims for damages to property or injuries to persons which may result directly or indirectly from work performed by EcoMosquito. Disclaimer EcoMosquito's liability under this agreement will be terminated if EcoMosquito is prevented from its responsibilities under this agreement by reasons of delays in transportation, shortages of fuel and/or materials, strikes, embargoes, quarantine restrictions or any other act of God or circumstances or cause beyond the control of EcoMosquito. EcoMosquito disclaims any liability for special, incidental, or consequential damages. The guarantees stated in this agreement are given in lieu of any other guarantee or warranties, express or implied, including any warranty or merchantability for a particular purpose. Chemical Sensitivity f the Customer or other Occupant(s) in or around the structure(s) believe they are or may be sensitive to pesticides/insecticides or their odors, the Customer must notify Company in writing prior to installation or treatment and must include information on whether Customer or Occupant(s) have consulted with a licensed medical doctor or other healthcare providers regarding such sensitivity. EcoMosquito reserves the right, upon such notification, to deny or terminate service. Failure to provide notification represents the Customer’s assumptions of risk and waiver of claims against the Company in connection with any chemical sensitivity. Please type your full name as it appears on your passport as indication that you have read the terms of service as listed above and agree to these terms: * Thank you!
