SVRS - Sorenson at Work

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Fields

Organization Information

Type of Organization*

Organization Name*

Organization Street Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Point of Contact Information

Point of Contact Name*

First Name*

Last Name*

Job Title*

Point of Contact Phone Number*

Point of Contact Phone Extension

Point of Contact Email Address*

How would you prefer us to contact you?

Email Phone

Are you Deaf or hearing?*

Deaf Hearing

Type of Service

What type of service are you looking for?*

I want a have a VP installed at my workplace I want to have interpreting services available at work

Is this videophone going to be used by one Deaf person or shared by multiple Deaf employees?*

How many videophones do you need?

Which endpoints are you interested in?

ntouch VP2 (most common) ntouch PC ntouch Mac ntouch Mobile ntouch Tablet I'm not sure

How often do you need an interpreter at work?

How many hours per month of interpreting do you anticipate needing?

Does your company currently have services through Sorenson?

Yes No

Interested in video relay service (VRS)?

Yes No

Individual or Shared VRS #?*

Interested in interpreting services?

Yes No

How many Deaf employees need interpreting services?

If individual, Employee Name*

+ add 2nd name?

Yes No

2nd Employee Name*

+ add 3rd name?

Yes No

3rd Employee Name*

+ add 4th name?

Yes No

4th Employee Name*

+ add 5th name?

Yes No

5th Employee Name*

+ add 6th name?

Yes No

6th Employee Name*

+ add 7th name?

Yes No

7th Employee Name*

+ add 8th name?

Yes No

8th Employee Name*

+ add 9th name?

Yes No

9th Employee Name*

+ add 10th name?

Yes No

10th Employee Name*

Employee(s) Deaf?*

Yes No

Referred By

Comments

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