Please adjust according to your needs. This serves only as an example and must be reviewed by your doctor and / or attorney. We are not liable for this being binding in any way.
I __________________________________________________, who represents ___________________________________________________, affirm that any pesticides we use are absolutely safe for all family members, including infants and pets. If this is a business, we affirm that the pesticides are safe for all employees and clients, including those with chemical sensitivities, cancer, or other autoimmune illness. If anyone, including a pet, gets sick from exposure to the pesticides, my company and I will assume full financial responsibility for all medical or veterinary costs. This includes medical conditions that may develop long after the application of the pesticide, even from low chronic exposures to residues. This affirmation also overrides any documentation in a pest control contract that prohibits the client from suing the company. We will also provide a copy of the label and Material Safety Data Sheet (MSDS) of any pesticides we use in or around your home or in your business.
Date______________________________
Company Applicator License No_____________
Technician Operator License No_______________________
Signature of Representative _________________________________________
Address of Application ______________________________________________
I __________________________________________________, who represents ___________________________________________________, affirm that any pesticides we use are absolutely safe for all family members, including infants and pets. If this is a business, we affirm that the pesticides are safe for all employees and clients, including those with chemical sensitivities, cancer, or other autoimmune illness. If anyone, including a pet, gets sick from exposure to the pesticides, my company and I will assume full financial responsibility for all medical or veterinary costs. This includes medical conditions that may develop long after the application of the pesticide, even from low chronic exposures to residues. This affirmation also overrides any documentation in a pest control contract that prohibits the client from suing the company. We will also provide a copy of the label and Material Safety Data Sheet (MSDS) of any pesticides we use in or around your home or in your business.
Date______________________________
Company Applicator License No_____________
Technician Operator License No_______________________
Signature of Representative _________________________________________
Address of Application ______________________________________________