New Customer Service Order
Billing Name:
Billing Address
City
State
ZIP
Email Address:
Physical Address
Should This Address be Listed on Account?  (Yes or No)
Federal Tax ID #
or    
Social Security #
D.O.B.
Number You Wish to Forward
Rollover or Back Numbers
May we give out?  (Yes or No)  
Office Hours
How would you like your account answered?

Individuals to be Listed on Your Account
Name
Title
Home Number
Mobile Number
Pager Number
E-Mail Address
Type
Name
Title
Home Number
Mobile Number
Pager Number
E-Mail Address
Type
Name
Title
Home Number
Mobile Number
Pager Number
E-Mail Address
Type
Name
Title
Home Number
Mobile Number
Pager Number
E-Mail Address
Type
Which numbers may be given out to callers
Home ?  (Yes or No)  
Mobile ?  (Yes or No)  
Pager ?  (Yes or No)  
Brief description of business
Additional account information

Information to be Obtained from the Caller
Name ?  (Yes or No)  
Address ?  (Yes or No)  
Phone ?  (Yes or No)  
Company ?  (Yes or No)  
Nature of Call ?  (Yes or No)  
Other Information
Do you want all calls, or just emergency calls delivered to on-call personnel ?
What steps does the operator need to follow to deliver these calls?
If using a numeric pager, does operator enter caller’s number, or answering service number ?
If operator leaves answering service number in pager, how much time should pass before moving to the next delivery step?

How Do You Want Calls Delivered Back To You The Next Business Day?
By Fax ? Fax Number Delivery Time
 (Yes or No)  

By E-Mail ? E-Mail Address Delivery Time
 (Yes or No)  

By Voice Mail? 4 Digit Password Outdial to Notify of Messages
 (Yes or No)  
Do you want only undelivered calls or all calls delivered back ?

Optional Services
Operator overflow – prerecorded greeting identifying your company that plays if operator cannot answer your call live within 3 rings ?
(no additional cost)		  (Yes or No)  

Auto Announce – prerecorded announcement identifying your company and hours of operation that plays everytime before operator answers the call live.
(100 free playbacks, then .10 per playback)		  (Yes or No)  

Patching – caller is connected directly to you.
(.35 per call )		  (Yes or No)  
Answering service number you will be using?
Contact name for future account updates?
Authorized Digital Signature (Your Name)
Date
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