TCB Answering Service Account Sign Up Form

Organization Name

Todays Date

Month Day Year

Organization Structure

Tax ID Number

Service To Begin on:

Month Day Year

Key Contact Name

E-mail

Phone Number

Area Code Phone Number

Company Web Site

Organization Physical Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Fax Number

Area Code Phone Number

What Package Would You Like?

Name to Appear on Billing

Billing Contact Person

First Name Last Name

Billing Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Billing E-mail Address

Billing Phone Number

Area Code Phone Number

Answering Phrase (how we answer your phone)

Physical Address To Provide Callers

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Phone Number To Provide Callers

Area Code Phone Number

Fax Number To Provide Callers

Area Code Phone Number

BACK LINE (our use only)

Area Code Phone Number

Mailing Address to Provide Callers

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

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 Name Last Name

Title

Phone Number (HOME)

Area Code Phone Number

Phone Number (CELL)

Area Code Phone Number

Cell Phone Provider

E-mail

Name

First Name Last Name

Title

Phone Number (HOME)

Area Code Phone Number

Phone Number (CELL)

Area Code Phone Number

Cell Phone Provider

E-mail

Name

First Name Last Name

Title

Phone Number (HOME)

Area Code Phone Number

Phone Number (CELL)

Area Code Phone Number

Cell Phone Provider

E-mail

Please use detail

Caller

Name Company Address Phone Number Message

Do you accept collect calls

YES NO

Do we ask callers if its an emergency

YES NO

What do you consider an emergency

Hold all calls, you will call in and check messages

YES NO

Send Text Message

YES NO

Page or call on All Calls

Every 10 Min Every 15 Min Every 20 Min Other

Page or call on ER calls only

Every 5 Min Every 10 Min Every 15 Min Every 20 Min Other

Alpha page once and clear call

YES NO

E-mail All Calls

As they come in Once a day NEVER

Fax All Calls

As they come in Once a day NEVER

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 INSURE QUALITY CONTROL.

ALL ACCOUNTS MUST USE A CREDIT or DEBIT CARD FOR MONTHLY PAYMENT. PLEASE CALL OUR OFFICE TO SET UP AUTO PAY 541-265-5265.

Do you agree to the above terms?

YES NO

Signature

TCB Answering Service Account Sign Up Form

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)