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Submit a GOLD Lead

Please complete the following form to submit your GOLD lead to the appropriate Sales team. Always use proper capitalization. Never submit customer information in ALL CAPS.

"*" indicates required fields

Source Employee Information

Source Employee (LastName, FirstName, EMPID)*

ex. Smith, John 9898

Source Employee - Cook's Email Address*

A confirmation email contain all lead informaiton will be sent to this email address once the form has been submitted.

Service Information

Which service(s) are they interested In?*

COMMERCIAL SERVICES

Pest Control - Residential

Termite Control - Residential

Mosquito Control - Residential

Bed Bug Removal - Residential

Brown Recluse Service - Residential

Fire Ant Service - Residential

Exterior Flea & Tick Service - Residential

Foundation Vents

Foundation Ground Covering

Crawlspace Door

You can select multiple services.

Zip Code of Property*

Servicing District Office*

Is this Lead for an Existing Customer?*

Yes

No

Unsure

Existing ServSuite Account (optional)

If they have an existing account and you know the account number, please enter it here.

Customer Information

Name*

First Last

Phone Number*

Always ask for a mobile phone number first.

Email Address (optional)

Full Street Address*

Street Address Address Line 2 City State ZIP Code

Notable Details for Sales Specialist/Inspector (optional)

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