HUD-NPCA-99-B New Construction Subterranean Termite Service Record

New Construction Subterranean Termite
Service Record

OMB Approval No. 2502-0525
(exp. 10/31/2011)

This form is completed by the licensed Pest Control Company

Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. This information
is mandatory and is required to obtain benefits. HUD may not collect this information, and you are not required to complete this form, unless it displays a
currently valid OMB control number.
Section 24 CFR 200.926d(b)(3) requires that the sites for HUD insured structures must be free of termite hazards. This information collection requires the
builder to certify that an authorized Pest Control company performed all required treatment for termites, and that the builder guarantees the treated area
against infestation for one year. Builders, pest control companies, mortgage lenders, homebuyers, and HUD as a record of treatment for specific homes will
use the information collected. The information is not considered confidential.
This report is submitted for informational purposes to the builder on proposed (new) construction cases when treatment for prevention of subterranean termite
infestation is specified by the builder, architect, or required by the lender, architect, FHA, or VA.
All contracts for services are between the Pest Control company and builder, unless stated otherwise.
Section 1: General Information (Pest Control Company Information)
Company Name: _ _______________________________________________________________________________________________________________________
Company Address _______________________________________________ City ___________________________State ________________Zip ________________
Company Business License No. __________________________________________ Company Phone No. _ ____________________________________________
FHA/VA Case No. (if any) _________________________________________________________________________________________________________________
Section 2: Builder Information
Company Name _________________________________________________________________________Phone No. ______________________________________
Section 3: Property Information
Location of Structure (s) Treated (Street Address or Legal Description, City, State and Zip) ________________________________________________________
Section 4: Service Information
Date(s) of Service(s)__________________________________________________________________________________________________________________________
Type of Construction (More than one box may be checked)

 Slab

 Basement

 Crawl  Other _____________________________

Check all that apply:

 A. Soil Applied Liquid Termiticide

Brand Name of Termiticide:____________________________ EPA Registration No. ____________________________

Approx. Dilution (%): _____________ Approx. Total Gallons Mix Applied: _____________ Treatment completed on exterior:

Brand Name of Termiticide:____________________________ EPA Registration No.____________________________

Approx. Dilution (%): _______________ Approx. Total Gallons Mix Applied: _______________

Name of System____________________________EPA Registration No. _______________ Number of Stations installed____________

Name of System____________________________ Attach installation information (required)

 B. Wood Applied Liquid Termiticide

 Yes  No

 C. Bait system Installed

 D. Physical Barrier System Installed




Yes
No
Service Agreement Available?
Note: Some state laws require service agreements to be issued. This form does not preempt state law.
Attachments (List) ____________________________________________________________________________________________________________________________
Comments _ _________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________
Name of Applicator(s) ___________________________________________________ Certification No. (if required by State law) _______________________________
The applicator has used a product in accordance with the product label and state requirements. All materials and methods used comply with state and federal
regulations.
Authorized Signature ____________________________________________________ Date _______________________________________________________________
Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties. (18 U.S.C. 1001, 1010. 1012; 31 U.S.C. 3729, 3802)
Form NPCA-99-B may still be used

form HUD-NPMA-99-B (08/2008)