ASSIGNMENT INTAKE INFORMATION

Todays date & time: Caller:

Company Representing: Position:
Telephone: Email:

ASSIGNMENT INFORMATION
Date(s): Address:
Time(s): Directions:
Parking Provided: Yes ____ No_____ Where to Park:
Person on Site to Contact: Telephone:
Consumer(s) Interpreting for: Sign Language Preference:
Team Interpreter:
Description of Assignment: Telephone:


BILLING
Amount quoted: Per:_______ Cancellation Policy:
Send Invoice to:
Contact: Scheduling Procedures:
Telephone:

*PAYMENT EXPECTED IN 30 CALENNDAR DAYS UNLESS OTHERWISE STATED.
LATE FEE POLICY: $_________ PER_______ DAYS DELIQUENT


ASSIGNMENT COMPLETION

Date: On Site Payment Received:
Invoice Mailed/Faxed: Check #:
Payment Received: Date:

Signature: _________________________________ Amount:___________________________________