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Dispatch Answering Service – Call Center

(610) 967-6355 Fax (610) 965-8440

Acct. DID # (Call Forward): ( )____________________ Billing Acct. # : ______________________

Company Name: ____________________________________

Physical Address: ____________________________________ Billing: ____________________________

____________________________________ ____________________________

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Business Telephone # : ( )_________________ Inside Line: ( )_______________________

Additional Line: ( )_________________ FAX #: ( )_______________________

Type of Business: ________________________________________________________________________

Business Hours: Monday - ___________ Thursday - ___________ Sunday - ______________

Tuesday - ___________ Friday - _____________ Holidays - _____________

Wednesday - __________ Saturday - ____________

Collect Calls: YES / NO (If Yes, Specify ____________________________________________)

On-Hold Music: YES / NO

Answer Phrase: ___________________________________________________________________________

Closing Phrase: (Optional) __________________________________________________________________

(I.e.: "If you do not get a return call within 15 minutes, please call back.")

Information To Be Secured From Caller: _____________________________________________________

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Dispatching Instructions: (What protocol do you want us to follow once the message has been taken?)

__________________________________________________________________________________________

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What do YOU consider an EMERGENCY? (Please specify)______________________________________

__________________________________________________________________________________________

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What types of messages are to be held for the Office? ____________________________________________

__________________________________________________________________________________________

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Special Instructions: _______________________________________________________________________

_________________________________________________________________________________________

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FAX Deliveries: (Please specify days/times you require FAX messages delivered):

D = Delivered Messages U/D = Undelivered Messages

Time Type Time Type

Monday - _____________ _____________ Friday - ______________ ___________

Tuesday - _____________ _____________ Saturday - ____________ ___________

Wednesday - __________ _____________ Sunday - ______________ ___________

Thursday - ___________ _____________


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Message Retrieval Requirements: (Please circle appropriate type.)

Alpha Pager Digital Pager Voice Mail E-Mail Cell Phone

(Message on Screen) (Phone # Displayed) (Verbal Message Left) (On-Line Messaging)

Paging Instructions: _______________________________________________________________________

_________________________________________________________________________________________

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Personnel Contacts: (If you need to have additional space – please use a blank sheet and attach to form.)

_____________________________ ( )______________ ( ) ______________ ( )______________

(Name) (Pager #) (Cell Phone #) (Residence #)

______________________________________________________________________

(E-Mail Address)

_____________________________ ( )______________ ( ) ______________ ( )______________

(Name) (Pager #) (Cell Phone #) (Residence #)

______________________________________________________________________

(E-Mail Address)

_____________________________ ( )______________ ( ) ______________ ( )______________

(Name) (Pager #) (Cell Phone #) (Residence #)

______________________________________________________________________

(E-Mail Address)

_____________________________ ( )______________ ( ) ______________ ( )______________

(Name) (Pager #) (Cell Phone #) (Residence #)

______________________________________________________________________

(E-Mail Address)

Referral Numbers: (Who covers for you when you are not available and/or Emergency #’s.)

_____________________________ ( )______________ ( ) ______________ ( )______________

(Name) (Pager #) (Cell Phone #) (Residence #)

_____________________________ ( )______________ ( ) ______________ ( )______________

(Name) (Pager #) (Cell Phone #) (Residence #)

How did you hear about our company? ______________________________________________________

Do you have a website address? If so, what is the address? _____________________________________

Please give directions to your business _______________________________________________________

COMPTROLLER NOTIFIED: _______________________ DATE: ____________________________

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