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Pest Control Service Request Form

Pest leads are pest-specific — termite inspection, bed bug heat treatment, and ant perimeter spray are completely different jobs. The form's first field is 'what kind of pest?' for a reason.

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form.htmlhtml54 lines
01<form action="https://splitforms.com/api/submit" method="POST">
02  <input type="hidden" name="access_key" value="YOUR_ACCESS_KEY">
03  <input type="hidden" name="subject" value="New pest control request">
04 
05  <label for="name">Full name *</label>
06  <input id="name" type="text" name="name" placeholder="Marcus Lim" required>
07  <label for="email">Email *</label>
08  <input id="email" type="email" name="email" placeholder="marcus@example.com" required>
09  <label for="phone">Phone *</label>
10  <input id="phone" type="tel" name="phone" placeholder="+1 555 0142" required>
11  <label for="address">Service address *</label>
12  <input id="address" type="text" name="address" placeholder="1247 Valencia St" required>
13  <label for="pest">Pest type *</label>
14  <select id="pest" name="pest" required>
15    <option value="">Choose…</option>
16    <option>Ants</option>
17    <option>Roaches</option>
18    <option>Rodents (mice / rats)</option>
19    <option>Termites</option>
20    <option>Bed bugs</option>
21    <option>Wasps / bees</option>
22    <option>Spiders</option>
23    <option>Multiple</option>
24    <option>Not sure</option>
25  </select>
26  <label for="severity">Severity *</label>
27  <select id="severity" name="severity" required>
28    <option value="">Choose…</option>
29    <option>Just spotted a few</option>
30    <option>Recurring problem</option>
31    <option>Widespread infestation</option>
32    <option>Inspection only</option>
33  </select>
34  <label for="last_treatment">Last professional treatment</label>
35  <select id="last_treatment" name="last_treatment">
36    <option value="">Choose…</option>
37    <option>Never</option>
38    <option>Within 6 months</option>
39    <option>Within a year</option>
40    <option>1–3 years ago</option>
41    <option>3+ years ago</option>
42  </select>
43  <label for="details">Where in the home?</label>
44  <textarea id="details" name="details" placeholder="Kitchen, attic, basement, exterior…"></textarea>
45 
46  <!-- honeypot — bots fill every field -->
47  <input type="checkbox" name="botcheck" style="display:none" tabindex="-1" autocomplete="off">
48 
49  <button type="submit">Send</button>
50</form>
51 
52<p style="margin-top:12px;font-size:11px;color:#888;text-align:right">
53  Powered by <a href="https://splitforms.com" style="color:#888;text-decoration:none" target="_blank" rel="noopener">splitforms</a>
54</p>
1,000
submissions / mo, free
8
fields, ready to ship
5
code outputs
60s
from copy to inbox
Pest Control Service Request Form — example splitforms template with submissions inbox
§ 01Why it mattersthe qualifying-fields argument

The pest dropdown isn't optional — termite work needs a licensed inspector and often a state-mandated WDI report; bed bug heat treatment needs different equipment and a 6-hour appointment window; rodent exclusion is a sealing job, not a spray job. Wrong truck, wrong tech, wrong day. Beyond pest type, capture severity (just saw one / multiple sightings / heavy infestation) and home size — that determines whether you can quote on the call or need to send an inspector first.

✦ at a glance
  • →Pest control quote · 8 fields
  • →HTML, JS, React, PHP, cURL outputs
  • →One POST endpoint, no SDK
  • →Honeypot + classifier, no CAPTCHA
§ 02Live previewinteractive · sandboxed · no key required

See exactly what your visitors see — and you’ll receive.

Left: the rendered form, fully interactive in a sandboxed iframe. Right: the email and dashboard view that lands the moment a visitor submits.

preview · pest-control-contact-formlocalhost:3000
✦ what you’ll see in your inbox

Every submission becomes an email plus a dashboard row. The fields below are the exact payload your form will send. Reply-to is wired to the visitor’s email so hitting reply goes back to them.

dashboard · new submission14ms · 200 OK
SUBJECT · New pest control request
Full name
Maya Iyer
Email
maya@studio71.co
Phone
+1 415 555 0142
Service address
—
Pest type
Ants
Severity
Just spotted a few
Last professional treatment
Never
Where in the home?
Loved your last open house in Hayes — looking for similar with parking. Pre-approved through Wells Fargo.

Iframe is sandboxed — submit doesn’t actually fire. Get your access key to wire it up live.

§ 03Three steps3 steps · ~60 seconds

Generate, embed, receive.

Three actions stand between you and your first lead. None of them require a backend, a database, or a CAPTCHA library.

STEP 01GENERATE

Pest type drives everything

Required dropdown: ants / roaches / termites / bed bugs / rodents / wasps / spiders / general. Each routes to a different specialist truck and a different price tier.

Create your form
key=sk_live_••••••••
STEP 02EMBED

Capture severity and home size

Severity (sighting / multiple / heavy) and home size (sqft) bracket the quote. Termite leads automatically get an inspection scheduled, not a quote.

snippethtml
<form action="https://splitforms.com/api/submit" method="POST">
  …
</form>
STEP 03RECEIVE

Offer recurring vs one-time

Most pest control revenue is recurring (quarterly perimeter spray contracts). Add a 'recurring service' checkbox — the customer who wants ongoing protection is worth 10x a one-shot.

inbox · 1 newjust now
FROM contact@yoursite.com
New pest control request
Maya Iyer maya@studio71.co
Loved your last open house in Hayes — looking for similar with parking. Pre-approved through Wells Fargo.
§ 04Copy & ship5 languages · same endpoint

Five outputs. One backend.

HTML by default. Click open the language you ship in — every variant POSTs to the same /api/submit endpoint.

01HTMLform.html54 lines
<form action="https://splitforms.com/api/submit" method="POST">
  <input type="hidden" name="access_key" value="YOUR_ACCESS_KEY">
  <input type="hidden" name="subject" value="New pest control request">

  <label for="name">Full name *</label>
  <input id="name" type="text" name="name" placeholder="Marcus Lim" required>
  <label for="email">Email *</label>
  <input id="email" type="email" name="email" placeholder="marcus@example.com" required>
  <label for="phone">Phone *</label>
  <input id="phone" type="tel" name="phone" placeholder="+1 555 0142" required>
  <label for="address">Service address *</label>
  <input id="address" type="text" name="address" placeholder="1247 Valencia St" required>
  <label for="pest">Pest type *</label>
  <select id="pest" name="pest" required>
    <option value="">Choose…</option>
    <option>Ants</option>
    <option>Roaches</option>
    <option>Rodents (mice / rats)</option>
    <option>Termites</option>
    <option>Bed bugs</option>
    <option>Wasps / bees</option>
    <option>Spiders</option>
    <option>Multiple</option>
    <option>Not sure</option>
  </select>
  <label for="severity">Severity *</label>
  <select id="severity" name="severity" required>
    <option value="">Choose…</option>
    <option>Just spotted a few</option>
    <option>Recurring problem</option>
    <option>Widespread infestation</option>
    <option>Inspection only</option>
  </select>
  <label for="last_treatment">Last professional treatment</label>
  <select id="last_treatment" name="last_treatment">
    <option value="">Choose…</option>
    <option>Never</option>
    <option>Within 6 months</option>
    <option>Within a year</option>
    <option>1–3 years ago</option>
    <option>3+ years ago</option>
  </select>
  <label for="details">Where in the home?</label>
  <textarea id="details" name="details" placeholder="Kitchen, attic, basement, exterior…"></textarea>

  <!-- honeypot — bots fill every field -->
  <input type="checkbox" name="botcheck" style="display:none" tabindex="-1" autocomplete="off">

  <button type="submit">Send</button>
</form>

<p style="margin-top:12px;font-size:11px;color:#888;text-align:right">
  Powered by <a href="https://splitforms.com" style="color:#888;text-decoration:none" target="_blank" rel="noopener">splitforms</a>
</p>
02JavaScriptform.js70 lines
<form id="lf-form">
  <label for="name">Full name *</label>
  <input id="name" type="text" name="name" placeholder="Marcus Lim" required>
  <label for="email">Email *</label>
  <input id="email" type="email" name="email" placeholder="marcus@example.com" required>
  <label for="phone">Phone *</label>
  <input id="phone" type="tel" name="phone" placeholder="+1 555 0142" required>
  <label for="address">Service address *</label>
  <input id="address" type="text" name="address" placeholder="1247 Valencia St" required>
  <label for="pest">Pest type *</label>
  <select id="pest" name="pest" required>
    <option value="">Choose…</option>
    <option>Ants</option>
    <option>Roaches</option>
    <option>Rodents (mice / rats)</option>
    <option>Termites</option>
    <option>Bed bugs</option>
    <option>Wasps / bees</option>
    <option>Spiders</option>
    <option>Multiple</option>
    <option>Not sure</option>
  </select>
  <label for="severity">Severity *</label>
  <select id="severity" name="severity" required>
    <option value="">Choose…</option>
    <option>Just spotted a few</option>
    <option>Recurring problem</option>
    <option>Widespread infestation</option>
    <option>Inspection only</option>
  </select>
  <label for="last_treatment">Last professional treatment</label>
  <select id="last_treatment" name="last_treatment">
    <option value="">Choose…</option>
    <option>Never</option>
    <option>Within 6 months</option>
    <option>Within a year</option>
    <option>1–3 years ago</option>
    <option>3+ years ago</option>
  </select>
  <label for="details">Where in the home?</label>
  <textarea id="details" name="details" placeholder="Kitchen, attic, basement, exterior…"></textarea>
  <button type="submit">Send</button>
</form>

<p style="margin-top:12px;font-size:11px;color:#888;text-align:right">
  Powered by <a href="https://splitforms.com" style="color:#888;text-decoration:none" target="_blank" rel="noopener">splitforms</a>
</p>

<script>
  document.getElementById('lf-form').addEventListener('submit', async (e) => {
    e.preventDefault();
    const data = new FormData(e.target);
    data.set('access_key', 'YOUR_ACCESS_KEY');
    data.set('subject', 'New pest control request');

    const res = await fetch('https://splitforms.com/api/submit', {
      method: 'POST',
      body: data,
      headers: { Accept: 'application/json' },
    });

    const json = await res.json();
    if (json.success) {
      e.target.reset();
      alert('Sent!');
    } else {
      alert('Error: ' + (json.message || 'Try again'));
    }
  });
</script>
03React / Next.jsForm.tsx85 lines
'use client';

import { useState, type FormEvent } from 'react';

export default function PestControlForm() {
  const [status, setStatus] = useState<'idle' | 'sending' | 'sent' | 'error'>('idle');

  async function onSubmit(e: FormEvent<HTMLFormElement>) {
    e.preventDefault();
    setStatus('sending');

    const data = new FormData(e.currentTarget);
    data.set('access_key', 'YOUR_ACCESS_KEY');
    data.set('subject', 'New pest control request');

    const res = await fetch('https://splitforms.com/api/submit', {
      method: 'POST',
      body: data,
      headers: { Accept: 'application/json' },
    });

    const json = await res.json();
    setStatus(json.success ? 'sent' : 'error');
    if (json.success) e.currentTarget.reset();
  }

  if (status === 'sent') return <p>Thanks — we&rsquo;ll be in touch.</p>;

  return (
    <>
    <form onSubmit={onSubmit}>
      <label htmlFor="name">Full name *</label>
      <input id="name" type="text" name="name" placeholder="Marcus Lim" required />
      <label htmlFor="email">Email *</label>
      <input id="email" type="email" name="email" placeholder="marcus@example.com" required />
      <label htmlFor="phone">Phone *</label>
      <input id="phone" type="tel" name="phone" placeholder="+1 555 0142" required />
      <label htmlFor="address">Service address *</label>
      <input id="address" type="text" name="address" placeholder="1247 Valencia St" required />
      <label htmlFor="pest">Pest type *</label>
      <select id="pest" name="pest" required>
        <option value="">Choose…</option>
        <option>Ants</option>
        <option>Roaches</option>
        <option>Rodents (mice / rats)</option>
        <option>Termites</option>
        <option>Bed bugs</option>
        <option>Wasps / bees</option>
        <option>Spiders</option>
        <option>Multiple</option>
        <option>Not sure</option>
      </select>
      <label htmlFor="severity">Severity *</label>
      <select id="severity" name="severity" required>
        <option value="">Choose…</option>
        <option>Just spotted a few</option>
        <option>Recurring problem</option>
        <option>Widespread infestation</option>
        <option>Inspection only</option>
      </select>
      <label htmlFor="last_treatment">Last professional treatment</label>
      <select id="last_treatment" name="last_treatment">
        <option value="">Choose…</option>
        <option>Never</option>
        <option>Within 6 months</option>
        <option>Within a year</option>
        <option>1–3 years ago</option>
        <option>3+ years ago</option>
      </select>
      <label htmlFor="details">Where in the home?</label>
      <textarea id="details" name="details" placeholder="Kitchen, attic, basement, exterior…" />

      <button type="submit" disabled={status === 'sending'}>
        {status === 'sending' ? 'Sending…' : 'Send'}
      </button>

      {status === 'error' && <p>Something went wrong. Try again.</p>}
    </form>

      <p style={{ marginTop: 12, fontSize: 11, color: '#888', textAlign: 'right' }}>
        Powered by <a href="https://splitforms.com" target="_blank" rel="noopener" style={{ color: '#888', textDecoration: 'none' }}>splitforms</a>
      </p>
    </>
  );
}
04PHPsubmit.php28 lines
<?php
// Drop into a PHP page. Receives a form POST and proxies it to splitforms.com.
// Useful when you want to add server-side validation or rate limiting.

if ($_SERVER['REQUEST_METHOD'] === 'POST') {
    $allowed = ['name', 'email', 'phone', 'address', 'pest', 'severity', 'last_treatment', 'details'];
    $payload = ['access_key' => 'YOUR_ACCESS_KEY'];
    $payload['subject'] = 'New pest control request';

    foreach ($allowed as $f) {
        if (isset($_POST[$f])) $payload[$f] = $_POST[$f];
    }

    $ch = curl_init('https://splitforms.com/api/submit');
    curl_setopt($ch, CURLOPT_POST, true);
    curl_setopt($ch, CURLOPT_POSTFIELDS, http_build_query($payload));
    curl_setopt($ch, CURLOPT_RETURNTRANSFER, true);
    curl_setopt($ch, CURLOPT_HTTPHEADER, ['Accept: application/json']);
    $response = curl_exec($ch);
    $status   = curl_getinfo($ch, CURLINFO_HTTP_CODE);
    curl_close($ch);

    header('Content-Type: application/json');
    http_response_code($status);
    echo $response;
    exit;
}
?>
05cURLtest.sh12 lines
curl -X POST https://splitforms.com/api/submit \
  -H "Accept: application/json" \
  -d "access_key=YOUR_ACCESS_KEY" \
  -d "subject=New pest control request" \
  -d "name=Jane Builder" \
  -d "email=jane@example.com" \
  -d "phone=+15555555555" \
  -d "address=Jane Builder" \
  -d "pest=Ants" \
  -d "severity=Just spotted a few" \
  -d "last_treatment=Never" \
  -d "details=Hello from cURL"

Replace YOUR_ACCESS_KEY with the key from your dashboard. That’s the only edit.

§ 04bUse this template with…17 frameworks · same backend

One template. Every framework.

The same field set works on every framework splitforms supports. HTML, React, Next.js, Vue, Astro, Hugo, WordPress — same POST, same backend.

Pest control quote for HTML/forms/htmlPest control quote for Next.js/forms/nextjsPest control quote for React/forms/reactPest control quote for Vue/forms/vuePest control quote for Astro/forms/astroPest control quote for Svelte/forms/sveltePest control quote for Webflow/forms/webflowPest control quote for Carrd/forms/carrdPest control quote for WordPress/forms/wordpressPest control quote for Tailwind CSS/forms/tailwindPest control quote for AJAX (vanilla JS)/forms/ajaxPest control quote for Hugo/forms/hugoPest control quote for Gatsby/forms/gatsbyPest control quote for Eleventy/forms/eleventyPest control quote for SvelteKit/forms/sveltekitPest control quote for Framer/forms/framerPest control quote for Nuxt/forms/nuxt
§ 06FAQ4 answered

Things people ask before they ship.

Direct answers, no marketing fluff. Missing one? Email hello@splitforms.com.

01Should termite leads use the same form?
Same form, different routing. Termite is a specialised licensed service with a different sales cycle (often tied to real-estate transactions). Webhook routes termite-flagged leads to your termite specialist.
02How do I quote bed bugs without an inspection?
You shouldn't — bed bug treatment ranges from $300 (single room chemical) to $3,000+ (whole home heat). Use the form to schedule a free inspection, then quote on-site.
03Can I sell recurring contracts via the form?
Yes — checkbox for recurring service plus a price-per-quarter dropdown. Customers who tick that box are signing intent; close them on the callback. Recurring revenue is the entire business model in pest.
04Does this work with PestPac / FieldRoutes / GorillaDesk?
Yes — webhook the submission as JSON. All three accept inbound leads via Zapier or native webhooks. Lead lands in your route software with pest type and address ready for scheduling.
✻ ✻ ✻

Ship your pest control service request form in 60 seconds.

1,000 free submissions per month. No credit card. Copy the snippet, paste your access key, watch leads land in your inbox.

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v0.1 · founders pricing locked in · early access open