Pre-Scheduled Assignment Request Form

***Please Note***

The following is required for all pre-scheduled calls:

• 48-hour notice required (business hours only)
• 1 – hour minimum / 2 hours max
• Expressed understanding and compliance with the cancellation policy (see following page)

Company Name*
Language*
Interpretation Service Type*
PLEASE NOTE - For VRI requests, languages available are: Amharic, French Canadian, French Guianese Creole, Gujarati, Haitian Creole, Hindi, Hmong, Hungarian, Italian Japanese, Kabuverdianu, Karen, Kinyarwanda, Khmer, Pashto, Persian (Farsi), Polish, Punjabi, Rohingya, Romanian, Rundi (Kirundi), Tigrinya, Urdu
Special Request (i.e. legal, medical, court):*
Date of Appointment*
MM slash DD slash YYYY
Time of Appointment*

: Hours

Minutes
Time Zone of Appointment*
If Other, please specify the Time Zone*
Approximate Duration of Call (1-hour minimum required*
Contact Name*
First Last
(This is the Contact to Reach for Assignment Confirmation)
Contact Phone Number*
Email*
Third-Party Dial-Out Number(s)*
Signature*
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Pre-Scheduled Assignment Request Form