Kim's Answering Service Inc

Inquiry Form: We're more than just an answering service. We offer services including live operator assistance, voice mail with emergency operator dispatch, order taking, scheduling appointments, and web-enabled services. We will customize a program to fit your needs. Please fill out the inquiry form to obtain more information.

Company Name

Company Address

City		State		Zip Code

Billing Address (if different)

Company Phone 1

Company Phone 2

Backline#		Website		Email Address

Fax#

Telephone To Be Answered As:

Office Hours (include Lunch Hours)

Type Of Business

What Address (if any) Do You Want Available Upon Request?

Do You Want Your Fax# To Be Given Out?

Names Receiving Calls

Specific Instructions For The Operators

Relay Instructions (what you wants us to do with the messages that we take) ex: being paged, faxed, you will etc. Please include Pager #s, Mobile #s, Resident #s, etc.

Name

Title

Home Phone

Home Address

BILLING INFORMATION

Monthly Rate Plan

Extra Charges (if any)

Sales Tax

KIM'S ANSWERING SERVICE, INC. (Terms & Conditions) *

****PAYMENT
Payment must be received before your service is started.  For same day service a copy of your payment check must be faxed as proof and mailed and received within five (5) days.  Disconnection of service for lack of start up payment will be re-connected when payment is received.

****BILLING/INVOICING
Our invoices are mailed on the 22nd of each month, with a due date of the 10th of the following month. Invoice include the base rate for the preceding month and overage calls from the previous month if applicable.  Overage calls are monitored through our billing software and often occur during extended use of the answering service.  The inital relay on any call is at no charge.  Additional relay attmepts due to no response are billed accordingly.  It is the responsibility of the subscriber to monitor their usage and response time and to be aware that over calls and additional relay attempts are not retracted or refundable.  Service plan changes are to be made between the first (1st) and the fifth (5th) of each month.  A $10.00 administration charge will apply for all service rate changes.  Copies of past invoices, statistic totals, etc. will be charged a minimum of two dollars per page.  All accounts subject to annual reviews and possible increases not to exceed ten percent of base rate.

****COLLECTIONS/PAST DUE ACCOUNTS
Payments not recived by the tenth (10th) of the month will incur a 1.5% late charge. All accounts in a 30+ days status will be charged a $25.00 collection fee.  Service accounts 60+ days will result in automatic termination of service.  The account wil be charged a reconnection fee of $25.00 and the account will be requred to be brought to a current accounting status.

****TERMS AND CONDITIONS
The Terms and Conditions form shold be filled out and returned, along with the account set-up information forms in order to begin service.

*****CANCELLTION OF SERVICES
A thirty (30) day advance written notice is required in order to cancel services.  Unused portions or any services are nonrefundable.

*****DISCLAIMER OF LIABILITY
Because of the numerous factors beyond our control, we will not be held liable for any costs resulting from mechanical or service provider interruptions and human errors, with the exception of traceable billing errors.

PLEASE READ, COMPLETE, SIGN AND RETURN THESES FORMS TO 817-370-8074.  ONLY THE PERSON RESPONSIBLE FOR PAYMENT IS AUTHORIZED TO ENDORSE THIS FORM.

>Person Responsible for Payment:

Address:

Phone:

SS Number/Tax Payer ID:

Company Name:

BY SIGNING THIS DOCUMENT, I AGREE TO THE TERMS AND CONDITIONS AS STATED ABOVE.

>Client's Signature:                      Date:

Printed Name:

* Required to submit this form

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