Central Mass. Mosquito Control

111 Otis Street Northborough, MA 01532

Ph. (508) 393-3055 Fax (508) 393-8492

Online Service Request Questionnaire

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IMPORTANT NOTICE: To receive service, you must live within our service area ß(click here).

This should be in response to a currently observed mosquito problem or need. Please assist our efforts by answering all questions fully. We may not respond to incomplete questionnaires, and will not respond to anonymous service requests. Response to this request will vary according to the current mosquito situation in the CMMCP service area. Please e-mail us or call 508.393.3055 and ask for Tim McGlinchy if you do not receive service within 2 weeks, or you require additional information. Thank you.

*REQUIRED FIELD – FORM WILL NOT SUBMIT WITHOUT THIS INFORMATION

First Name:   *Last Name:

*Street Address:

Nearest cross street:

*City/Town:    State:       Zip Code:  

Daytime Phone#     Nighttime Phone#  

Fax Phone#   *E-mail Address:

*Do you request spraying for adult mosquitoes?: Choose One Yes No

Time of adult mosquito annoyance: Choose One Morning Daytime Early Evening Nighttime All of the above Not applicable

*Do you request an application to a stagnant water in your area?: Choose One Yes No

Source of suspected mosquito problem: Choose One Unknown Wetland/Swamp Artificial Container Ornamental Pool Swimming Pool Catch Basin Pond Non-flowing Ditch Beaver Dam Clogged Culvert Other

If other, please specify:

Location of suspected mosquito source (please be as specific as possible):

Questions or Comments (please add any information that may be helpful to the Technician assigned to this service request, such as specific instructions about the location, a concise description of the problem, warnings about dogs in the area, areas of special concern, or any assistance we may need in contacting you or completing our task):

A Technician will be assigned to investigate this request as soon as possible. The results of this investigation may result in the application of a site specific mosquito insecticide. Pre-determined thresholds of larval and/or adult mosquitoes must be present at the time to warrant this targeted application. If current conditions do not exist at the time (poor weather, insufficient mosquito numbers, etc.), this investigation may be rescheduled to a future date. Please call our office at 508.393.3055 if you require additional information. For information on the products used by CMMCP, please click here.

*Do you understand the statement above and give your consent? Choose One Yes No

PLEASE PRESS “SUBMIT” ONLY ONCE – THANK YOU!!