* required fields

*First Name:  
*Last Name:  
Company:
*Address 1:
Address 2:
City:
State: Zip: 
Office Hours
Lunch
Web Site
*Email:
Business Type
Contact Person
Contact Person Phone
Billing Contact
Billing Contact Phone
Area of Interest
How did you hear about us?
Phone Numbers  
Work:
 Fax:
Mobile:
Best time to reach you:
Reaching Instructions Please list the types of calls that you want to be reached on:
1
2
3
4
  Please list the types of calls that you do not want to be reached on:
1
2
3
4
  Please list the steps that our dispatchers should take in order to reach you:
1
2
3
4
  Please list the information you want us to retrieve from your callers:
1
2
3
4
Paging Info If we are reaching via pager or text message, please answer the following questions:
Paging Carrier Alpha/Numeric?
If alpha, do you want text messages or email to text?   

If Email, what is the address of your pager/phone:  

Non Emergency Message Retrieval  
Would you like your non-emergencies typed or put into voicemail?   
Emailing We send email messages individually as we take them.  What email address(es) would you like your messages sent to:
 
 
 
Employee Directory  
Name Cell Res Pager

   
   
   
       
   
   

This information will only be used by UNiCALL and will be kept strictly confidential.

 

 

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UNiCALL
2216 W. Altorfer Dr.
  
  Peoria, IL  61615     Phone  1-877-859-5333

Copyright 2007 UNiCALL - All Rights Reserved