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Structure Registration Form: Bayer Environmental Science P O Box 143, Isando, 1600 - Fax No: 011 921-5754

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Ducken Brise
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58 views

Structure Registration Form: Bayer Environmental Science P O Box 143, Isando, 1600 - Fax No: 011 921-5754

Uploaded by

Ducken Brise
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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STRUCTURE REGISTRATION FORM

Please fill out the information below and fax within 14 days of completion of the job to:
Bayer Environmental Science
P O Box 143, Isando, 1600 - Fax No: 011 921-5754
(Also remember to keep a copy on file for your records)

Approved Premise® 200 SC applicator name: ……………………………………………………………………………..

Address: ………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………….

Tel No: ………………………………………………… Fax No: ……………………………………………..................

Owner of site / building treated: ……………………………………………………………………………………………

Address of site / building treated : ………………………………………………………………………………………….

…………………………………………………………………………………………………………………………………

Tel No: ………………………………………………… Fax No: ……………………………………………................

Structure treated (tick one) a) Home ....... b) Multi-dwelling ……. c) Office building ....... d) Other …………

Treatment type: a) Pre-construction:

Total m2 treated: ………………………………………………………………………………..

Total litres applied: ……………………………………………………………………………..

b) Post construction:

Drill spacing: ……………………………………………………………………………….......

Litres / hole: …………………………………………………………………………………….

Total metres treated: …………………………………………………………………………..

Total litres applied: ……………………………………………………………………………

Date of termite application: ……………………………………………………………………………………………….

Were any other termiticides applied: Yes / No

If Yes, please furnish the information below:

Product Date applied Rated used Litres used m2 treated Termite sp treated

………………………………………………………………………………………………………………………………..

………………………………………………………………………………………………………………………………..
Declaration:
I, ……………………………………………………………… certify that the above information is correct and should
there be willful misrepresentation or omission, it will invalidate the “5 year pledge”

…………………………………………………….
(Signature)

Premise® is a registered Bayer trade mark.


Always remember to read and follow label directions.

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