File an E-Claim

1. Consumer Information

Consumer Name

Name of party who signed contract (if different)

Date Terminix contract was signed

Terminix contract number

You may provide your Terminix Customer Number or Terminix Sales Agreement Number

Mailing Address

City

State
---Alabama

ZipCode

Email

Phone Number

Mobile Number

The property serviced by Terminix is the same address as my mailing address.
yesno

If "NO" above, please enter serviced property address, with city, state and zip code

2. Property Damage Claims

3. Other Claims

If you are an existing or former Terminix customer in the State of Alabama, and you have been unable to resolve your dispute with Terminix, you are entitled to submit that dispute to the Receiver.

Are you an existing or former Terminix customer:
existingformer

Have you already tried to resolve this dispute with Terminix directly since the issuance of the Consent Judgment on December 2, 2020:
yesno


Please describe the nature of your dispute and, if applicable, the cost or amount paid to resolve the dispute:

ATTESTATION

Supporting Documents: Please attach copies of any documents that support your claim, such as: (a) a copy of your contract with Terminix; (b) a copy of your contract with another provider for the years 2019 and/or 2020 (if applicable); (c) copies of your cancelled checks to your new provider for the years 2019 and/or 2020, or other documentation reflecting payments made by you to your new provider for the years 2019 and/or 2020 (if applicable); (d) copies of pictures of property damage (if applicable).


Click to choose documents to upload
To select multiple documents, hold the CTRL key while clicking on the documents




DO NOT SEND ORIGINAL DOCUMENTS. THE DOCUMENTS YOU SEND MAY BE DESTROYED AFTER SCANNING. If the documents are not available, please explain below:

I declare under penalty of perjury that the above information is correct.
Date

Enter your full name as your Electronic Signature