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 - ___________ _____________
Sheet 2 of 2
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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