Mosquito Control Service Request Form

First Name *

Last Name *

Company Name

Phone *

Email Address *

It is OK to Contact Me via Email

Yes

House Number

Street

City

Zip Code

Nearest Cross Street

Mosquito Problem

I Have a Mosquito Problem

Permission to Check/Treat as Needed

No

Yes

Do you give Benton County Mosquito Control permission to enter your property without you being present at the time?

Are Mosquitoes Biting?

No

Yes

When Are They Biting?

Morning

Day

Dusk

Night

Select all times in which mosquitoes are biting

Where Are They Biting?

Indoors

Outdoors

Indicate where you are encountering mosquitoes

Mosquito Problem Details

Please enter any other details that may help us resolve this issue

Water Site to Check

I Have a Water Site to Check

Do you own the property that this water site is located upon?

No

Yes

Permission to Treat Water Site

No

Yes

Do you give Benton County Mosquito Control permission to enter your property without you being present at the time?

Can you provide us with owner’s contact information?

Please provide a detailed description as to the location of the water site you would like us to survey

Please check any boxes that apply to this water site:

I suspect that mosquitoes are present

I am concerned that mosquitoes could develop at the site

I would like guidance on what I can do to limit or negate mosquito development at this site

Are there any gates we need to go through or fences to cross to get to the water site?

No

Yes

Please describe gate location or fence type and best entry point

Are there any pets or livestock that we need to be aware of near the water site?

No

Yes

Please tell us what animals we should expect and any related information

Mosquitofish (Gambusia)

I am Interested in Mosquitofish

Do you own the property where the mosquitofish will be placed?

No

Yes

Can you provide us with owner’s contact information?

Initials Initials (REQUIRED for delivery)

I have read and understand the terms for delivery below

Yes (REQUIRED for delivery)

“Gambusia affinis is not an indigenous (native) species to Washington. Benton County Mosquito Control District #1 has been given permission by the Washington State Department of Fish and Wildlife (WDFW) to use Gambusia as a biological control method for mosquito larvae. We, therefore inspect potential sites before we transport any Gambusia to that area. It is illegal for any person not authorized by the WDFW to transport, distribute or introduce Gambusia into any water site.”

Permission to Place Fish

No

Yes

Do you give Benton County Mosquito Control permission to enter your property without you being present at the time?

Please provide a detailed description of the water site (size, gallons, etc.)

Are there any gates we need to go through or fences to cross to get to the mosquitofish site?

No

Yes

Please describe gate location or fence type and best entry point

Are there any pets or livestock that we need to be aware of near the mosquitofish site?

No

Yes

Please tell us what animals we should expect and any related information

Additional Information

I Would Like Additional Information

Please provide us with a brief description of the information you would like

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Mosquito Control Service Request Form