Affiliate Code / Promo Code (if applicable):    

PLEASE FILL OUT AS MANY FIELDS AS YOU CAN. ONCE WE RECEIVE YOUR INFORMATION, A CUSTOMER SERVICE REPRESENTATIVE WILL CONTACT YOU TO REVIEW AND COMPLETE SETUP OF YOUR TWO WEEK FREE TRIAL.

Preferred Start Date: (month/day/year) 

 
Company Name:    
Company Website Address:
Answer phrase:  (greeting to use when picking up your lines)    
Business Description / Services that you provide:

Estimate of Monthly Call Volume:  < 25    25 - 50    50 - 75    75 - 100    100 - 150    150 - 200    200 - 250    300 +  

Person Filling out this form:   
Main Phone #:  Back Line #:  Fax #:  
Do you want a copy of your messages faxed or emailed in the morning?  neither   both   fax messages    email messages  

 If "Yes" to fax or e-mail, what Time?  

If report is to be emailed, list email address report should be sent to (you may list multiple addresses)
      
Physical Address: Billing Address:
Office Hours 
Time Zone:  		Accounts Payable Contact:
Accounts Payable Phone:

Hold Calls overnight (i.e. do not contact you with every call)?

If "YES", hold call from to

 

 Information Needed on Message Ticket
 *Name, Phone, & General Message are always taken
Please include all other information we need from your callers

 

 
Please list the type of calls that should be dispatched immediately
(list calls you need to be contacted ASAP for, all other calls will be held for the office)

 

 Oncall Staff Names and Contact Numbers
(you may fax or e-mail employee phone lists and on call calendars to:
1-888-844-4129 or to info@specialtyansweringservice.net)
If you have pagers, please note if they are text pagers or numeric only
Contact Instructions (for calls not being held for office i.e. calls we need to contact you for):
If we can't reach on-call (representative from your company we contact for ASAP response calls) in what steps should we take:

 
Problems with Current or Previous Service We Can Improve Upon: