New Account Sign Up Form

Organization Name

Todays Date

MonthDayYear

Key Contact Name

Key Contact E-mail

Key Contact Phone Number

Area CodePhone Number

Organization Physical Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

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*

What Call Package Would You Like?

www.tcbanswering.com/pricing

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)

Company Web Site

Will you need an on-call schedule template? (For rotating on-call schedules)

YesNo

What do you consider to be routine calls (Non ER)? Example: Inquiring about a death certificate, obituary, pre needs. etc.

What do you consider to be urgent calls? Example: First calls, distressed family member.

Additional information we should know about your operation? Example: Pricing, directions to office, FAQ.

Please choose the items you want to have included in your first call information

Additional Information you would like collected for first calls:

How do you want your urgent calls dispatched- Select all that apply.

CallTextEmailOther

Relay Calls On The Phone To Oncall For Emergency Calls

Specifics for dispatching first calls:

How do you want your urgent calls dispatched- Select all that apply.

If you selected daily call log delivery @ what time

OTHER DELIVERY INFORMATION

Be Specific

How did you hear about us? If you were referred by someone please put their name or business in the "Other" field.

Company WebsiteGoogleSocial MediaOther

SUBSCRIPTION AGREEMENT

This agreement is made between the undersigned party (hereinafter referred to as the “Subscriber”) and TCB Management Group, Inc., in accordance with the terms and conditions outlined below.

SERVICE COMMENCEMENT
TCB Management Group, Inc. will not initiate telephone answering services for the Subscriber until this agreement has been duly executed and returned, along with the necessary account information and payment for one month’s service.

AMENDMENTS
Any modifications to this agreement or changes to Subscriber procedures must be documented in writing and signed by an authorized representative of both the Subscriber and TCB Management Group, Inc.

RESPONSIBILITIES
TCB Management Group, Inc. does not warrant or guarantee error-free service. However, the company pledges to make its best efforts in providing quality service. By executing this agreement, the Subscriber acknowledges that TCB Management Group, Inc. is not liable for any errors, damages (incidental or consequential), or loss of revenue. The company’s liability, if any, is limited to actual damages, and under no circumstances shall it exceed one month’s basic service charge.

The answering service will include, within equipment capabilities, the handling of calls made to the Subscriber’s designated phone line in accordance with written instructions provided by the Subscriber.

SUBSCRIBER RESPONSIBILITIES
The Subscriber agrees to provide and maintain the following current and accurate information with TCB Management Group, Inc.:

Telephone numbers answered by TCB Management Group, Inc.
Office locations
Names of individuals authorized to receive call-related information
Correct telephone, pager, and mobile numbers for employees and authorized personnel
Information regarding on-call employees
Billing details
Failure to provide or update this information may result in service errors, damages, or revenue loss, for which the Subscriber assumes full responsibility. TCB Management Group, Inc. shall not be held liable for any failure of the Subscriber’s employees to respond to messages.

PAYMENT TERMS
All service charges are due in full by the 10th of each month. If the Subscriber does not receive a statement by the 30th of the month, they must contact TCB Management Group, Inc. to request a copy. A late payment fee of 3.5% per month may be applied to overdue balances.

SERVICE TERMINATION
Either party may terminate this agreement with thirty (30) days’ written notice.

TCB Management Group, Inc. reserves the right to terminate this agreement without prior notice if subscription charges remain unpaid for thirty (30) days or more. In such cases, service may be discontinued on or after the 10th of the month. Termination due to non-payment does not exempt the Subscriber from fulfilling outstanding financial obligations, including collection costs, attorney fees, and court fees.

If service is disconnected due to non-payment, a $25.00 reconnection fee will apply.

SERVICE INTERRUPTION
TCB Management Group, Inc. shall not be held liable for service interruptions caused by equipment failure, acts of God, or any circumstances beyond its control. Such interruptions shall not be deemed a breach of contract.

RATE ADJUSTMENTS
TCB Management Group, Inc. reserves the right to adjust service rates with thirty (30) days’ written notice. Such rate changes shall take effect without altering the terms of this agreement.

SEVERABILITY
If any provision of this agreement is deemed invalid or unenforceable by a court of competent jurisdiction, the remaining provisions shall remain in full force and effect.

MESSAGE & CALL UNITS
Message Unit: Defined as any incoming or outgoing call or text message relayed to the Subscriber.
Call Unit: Defined as any incoming or outgoing call lasting up to two minutes. Calls exceeding this duration will incur additional call unit charges.

QUALITY MONITORING
To ensure quality control, telephone calls may be monitored or recorded by supervisory personnel.

AUTOMATED PAYMENTS
All accounts are required to enroll in AutoPay via ACH. Subscribers wishing to use a credit card must contact TCB Management Group, Inc. at 541-265-5265, Option 1.

Do you agree to the above terms.

I AGREE

Account Type

Business CheckingPersonal CheckingSavings

Bank Name

Name on Account

Account #

Routing #

Bank City & State

I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify TCB Security Services, INC. in writing of any changes in my account information or termination of this authorization at least 15 days prior to the next billing date. If the above noted periodic payment dates fall on a weekend or holiday, I understand that the payment may be executed on the next business day. I understand that because this is an electronic transaction, these funds may be withdrawn from my account as soon as the above noted periodic transaction dates. In the case of an ACH Transaction being rejected for Non Sufficient Funds (NSF) I understand that TCB Security Services, INC may at its discretion attempt to process the charge again within 30 days, and agree to an additional 1.5% charge for each attempt returned NSF which will be initiated as a separate transaction from the authorized recurring payment. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law. I agree not to dispute this recurring billing with my bank so long as the transactions correspond to the terms indicated in this
authorization form.

Do you agree to the above terms?

YESNO

Signature

Please verify that you are human*

New Account Sign Up Form

Organization Information

Billing Information

General Account Information

Staff Information (Contacts we need information for)

Specific Operation Details

First Call Specific Details

Non Urgent Message Handling

MORE INFORMATION (use this space for specific instructions on anything not covered above)

General Terms & Conditions

ACH ACCOUNT INFORMATION