Contact/Billing Information

Sales Rep ID/Agent #

Office Referred By Acct #

Referred By Name

Billing Start Date

Acct #

Company Name

Contact Name

Billing Address

City

State

Zip Code

Office #

Mobile #

Fax #

Billing E-Mail (1)

Billing E-Mail (2)

Account Info

Number of Phone Lines in the Office

Main Office Number

Rings to Which Line?

Local Phone Company

Dedicated Fax Line
YesNo

Is there VoiceMail on your phone system?
YesNo

Is VoiceMail active?
YesNo

Is there a Call Forwarding feature on the mainline?
YesNo

Toll-Free Number

Will it be forwarded to the service?
YesNo

Office Hours

Lunch Hours

Nature of Business

Area of Specialty

How would you like us to answer your phone?
ReceptionistOff-Site ReceptionistAnswering ServiceExchange

Which information would you like us to give out if asked? (Check all that apply)
Office AddressCross StreetEmailWebsite Address

Caller Information to Obtain

Generally, the following information is obtained:
a. Caller's First and Last Name
b. Caller's Phone Number
c. A Brief Message
If you would like us to ask additional questions, please list those below (Max 3 more):

Additional Question 1

Additional Question 2

Additional Question 3

Contacts for Receiving Messages

List names of all Contacts who will be receiving messages, and indicate how they prefer to receive their messages. Check all that apply.

Contact 1 Name

Receive messages via:
TextEmail

Contact 2 Name

Receive messages via:
TextEmail

Contact 3 Name

Receive messages via:
TextEmail

Do you accept Collect Calls?
YesNo

We require a 4-digit Numerical Security Code when programming an account. Please select a 4 digit code (not 1234).

Would you like us to record calls on your account? (Please note that there is a $10/mo. charge for call recording).
YesNo

Contact Details for Receiving Messages

Name

Text (Cell Number)

Carrier