PESTICIDE SECTION:
Regulates the distribution and application
of pesticides in the State of Indiana

 


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Telephone: 765-494-1492
FAX: 765-494-4331
Mon-Fri, 8-5 p.m.


Office of Indiana State Chemist
© Copyright - 2010
All Rights Reserved

Termite Pre-Treat Notification

Please submit this form at least three (3) hours prior to application on a customer's property.
All fields on this form are required.

Date and Time of Treatment

:   a.m.  p.m.


Certified Applicator Information



Customer (Treatment Site) Information


<1,000 FT2
1,000 - 5,000 FT2
5,000 - 10,000 FT2
>10,000 FT2



Click HERE to open a PDF version of this form. It can be filled out onscreen and then faxed to George Saxton at 765-494-4331.