TCB Answering Service Account Sign Up Form

Organization Name

Todays Date

MonthDayYear

Organization Structure

Tax ID Number

Service To Begin on:

MonthDayYear

Key Contact Name

Key Contact E-mail

Phone Number

Area CodePhone Number

Who Provides your business telephone service?

Company Web Site

Organization Physical Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Fax Number

Area CodePhone Number

What Call Package Would You Like?

www.tcbanswering.com/pricing

Name to Appear on Billing

Billing Contact Person

First NameLast Name

Billing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Billing E-mail Address*

Billing Phone Number

Area CodePhone Number

Answering Phrase (how we answer your phone)

Physical Address To Provide Callers

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number To Provide Callers

Area CodePhone Number

Fax Number To Provide Callers

Area CodePhone Number

BACK LINE (our use only)

Area CodePhone Number

Mailing Address to Provide Callers

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Email Address to Provide Callers

Office Hours & Lunch Hour Information (be as detailed as you can)

Directions to your office if needed for callers

Name

First NameLast Name

Title

Phone Number (HOME)

Area CodePhone Number

Phone Number (CELL)

Area CodePhone Number

E-mail

Name

First NameLast Name

Title

Phone Number (HOME)

Area CodePhone Number

Phone Number (CELL)

Area CodePhone Number

E-mail

Name

First NameLast Name

Title

Phone Number (HOME)

Area CodePhone Number

Phone Number (CELL)

Area CodePhone Number

E-mail

Please use detail

Caller

Do you accept collect calls

YESNO

Do we ask callers if its an emergency

YESNO

What do you consider an emergency

Send Text Message

YESNO

Page or call on All Calls

Every 10 MinEvery 15 MinEvery 20 MinOther

Page or call on ER calls only

Alpha page once and clear call

YESNO

E-mail All Calls

As they come inOnce a dayNEVER

Fax All Calls

As they come inOnce a dayNEVER

If you selected once a day delivery @ what time

OTHER DELIVERY INFORMATION

Be Specific

The undersigned hereafter referred to as subscriber, hereby, subscribes to the services of TCB Security
Service, Inc. in accordance with the terms and conditions below.

IT IS EXPRESSLY UNDERSTOOD AND AGREED THAT TCB SECURITY SERVICE, INC. WILL NOT
COMMENCE the provision of telephone answering service to the SUBSCRIBER until such time
SUBSCRIBER executes this agreement and returns it to TCB Security Service, Inc. with completed
account information and payment in the amount of one month’s service.

ALL AMENDMENTS TO THIS AGREEMENT AND SUBSCRIBER PROCEDURES MUST BE IN WRITING,
SIGNED BY AUTHORIZED REPRESENTATIVE AND ACCEPTED BY AUTHORIZED REPRESENTATIVE OF
TCB SECURITY SERVICE, INC.

RESPONSIBILITIES:
TCB Security Service, Inc. CANNOT WARRANT OR GUARANTEE THAT SERVICE ERRORS WILL NOT
OCCUR. TCB Security Service, Inc. pledges its best efforts. The SUBSCRIBER acknowledge by executing
this agreement that TCB Security Service, Inc. will not be liable for ANY errors, damages, incidental or
consequential, or loss of revenue. TCB Security Service, Inc. has limited liability for any actual damages.
IN NO EVENT WILL TCB Security Service, Inc. LIABILITY BE GREATER THAN ONE MONTH'S BASIC

SERVICE CHARGE.
Answering service shall mean, WITHIN EQUIPMENT CAPABILITIES, answering calls made to the
SUBSCRIBER'S incoming telephone line to the SUBSCRIBER in the manner indicated in writing and signed
by the SUBSCRIBER.

SUBSCRIBER RESPONSIBILITIES:
PROVISION OF INFORMATION: SUBSCRIBER shall provide TCB Security Service, Inc. with current
telephone numbers answered by TCB Security Service, Inc., current office locations, current names of
persons authorized to receive information concerning calls, current and correct telephone, pager and
mobile numbers for employees and persons authorized to receive call, current and correct information of
persons who will be receiving calls as ON CALL EMPLOYEE(S). SUBSCRIBER shall provide TCB Security
Service, Inc. current billing information.

Should SUBSCRIBER fail to provide TCB Security Service, Inc. with any of the above information,
SUBSCRIBER accepts full responsibility for any resulting errors, damages or loss of revenue.
TCB Security Service, Inc. will not be held liable in any way for SUBSCRIBER'S employee’s failure to
respond to SUBSCRIBER'S messages.

SUBSCRIBER AGREES AND UNDERSTANDS THAT CHARGES ARE DUE IN FULL BY THE TENTH (10) OF
THE MONTH. SUBSCRIBER further acknowledges that should statement not be received by SUBSCRIBER
on or before the 30th day of the month, SUBSCRIBER agrees to contact TCB Security Service, Inc. and
obtain copies of SUBSCRIBER'S statement. SUBJECT TO STATE LAW, A LATE PAYMENT CHARGE OF
THE LESSER OF THE MAXIMUM LAWFUL INTEREST RATE OR 1.5% PER MONTH MAY BE ASSESSED ON
OVERDUE BALANCES.

TERMINATION OF SERVICE:
TCB Security Service, Inc. and SUBSCRIBER acknowledges that this agreement may be terminated upon
thirty (30) days written notice by the terminating party.
TCB Security Service, Inc. reserves the right to terminate this agreement without notice and discontinue
all service on or after the 10th day of any month if the subscription charges become thirty (30) days or
more delinquent. Such termination shall not preclude recovery of any and all sums due TCB Security
Service, Inc. hereunder, together with attorney's fees, court costs and all costs of collections.
If answering service is disconnected for non-pay there will be a $25.00 reconnect fee due at the time of
reconnection.

INTERRUPTION OF SERVICE:
TCB Security Service, Inc. will not be liable or obligated in any manner, nor shall it be considered a breach
of its duties hereunder, should TCB Security Service, Inc. be unable, due to equipment failure, acts of God
or any other cause beyond the control of TCB Security Service, Inc.., to provide SUBSCRIBER the service
described herein.

RATE INCREASES:
SUBSCRIBER acknowledges that the rate applicable to the service provided hereunder may be adjusted by
TCB Security Service, Inc. upon thirty (30) day written notice. Such adjustments shall take effect without
otherwise affecting the terms of this agreement.

SEVERABILITY CLAUSE:
In the event a court of competent jurisdiction determines that any provision of the Agreement is void or
not enforceable, such determination shall effect only the provision in question and shall not impair the
remaining provisions.

MESSAGE UNIT:
A message unit is described as any incoming or outgoing call, text message that is sent to relay
information to the subscriber.

TELEPHONE CALLS MAY BE MONITORED BY SUPERVISORY PERSONNEL, RECORDING DEVICES OR
BOTH TO ENSURE QUALITY CONTROL.

ALL ACCOUNTS ARE REQUIRED TO ENROLL IN AUTO PAY WITH ACH. iF YOU PREFER TO USE A CREDIT CARD, PLEASE CONTACT OUR OFFICE AT 541-265-5265 OPTION 1

Do you agree to the above terms.

I AGREE

Type a question

Clear

TCB Answering Service Account Sign Up Form

General Organization Information

Billing Information

General Account Information

Staff Information (Contacts we need information for)

Tell Us About Your Operation (what do you do, not do, etc)

Caller Information (please check all that apply or you would like us to collect)

Message Dispatching Information (how do you want to receive your messages)

MORE INFORMATION (use this space for specific instructions)

General Terms & Conditions

ACH ACCOUNT INFORMATION