Formulario de creación de una nueva cuenta

Client Information

Company Name of New Account*

Email of New Account*

Name of Umbrella Company

(if relevant)

Address of New Account*

Physical address only. No PO Boxes. (If the new account covers multiple locations, it is okay to specify as such.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Industry*

Please select the most appropriate industry. The form will only allow you to select one.

Customized Billing

Your invoice will automatically include the date, time, length, total cost, and language needed for each call. In addition to the information above, AOT can collect customized billing specifics from each caller to appear on data reports alongside standard call data. Please enter the information you wish to be collected below.

NOTE: If you indicate “YES” (required for billing), the caller will NOT be connected to an interpreter without this information. We are happy to install a dropdown menu to ensure order accuracy for any specifics.

Information to be Collected

Example: Caller’s name

Required for Billing?

Yes
No

Example: Department code

Required for Billing?

Yes
No

Example: LEP’s name

Required for Billing?

Yes
No

Example: Patient's ID number

Required for Billing?

Yes
No

If “YES” to any of the above, please provide below the name and phone number of a contact within your company who callers can be referred to should they not have the billing information required for connection.

Contact Name

A specific point of contact is preferred. Should a caller not know their department code, for example, the caller will be politely refused service and referred to contact person for assistance. In some situations, “Supervisor or Manager” or similar is acceptable.

Contact Phone Number:

Special Instructions

Please indicate any special connection instructions this account may have. For example: “female interpreters only” or “always ask callers if a third-party dial-out is needed.”