PIE Incorporated New Interpreter Request Form

New Interpreter Request Form

Thank you for using Professional Interpreter Exchange. To request an interpreter, either open and print the document from here and fax it to us, or complete the form below:

Request Information

An * denotes a required field or section

If you know your companys PIE Inc. Customer Number enter to pre-fill form:

Company Name Required
*Name (Bill to):

Requester Required
*Requester:

Onsite Contact Required
*Onsite Contact:

Onsite Phone Required
*Onsite Phone Number:

P.O./Contract No.:

Phone Required
*Phone:

Fax:

Requester Email Required
*Requester's Email:

*Billing Address:
Street Address: Billing Address Required
*City: Billing City Required	State: Billing State Required Zip: Billing ZIP Required

Assignment Address: .
Street Address: Location Street Required
City: State: ZIP: Location City Required Location State Required Location ZIP Required
Floor Number:	Room Number:

*Assignment Specifics

Event Date	Start - End Time	Interpreters Desired	Description/Topic

Please Enter an Event description Interpreters must be between 1 and 100. Enter a valid Event date
Reminder: Any assignment lasting longer than two (2) hours will require two (2) interpreters, unless the assignment is approved by our office for one (1) interpreter.

*Additional Assignment-Related Information

We must have this information in order to provide the best service.

1. Deaf Client's name:

Client is required

2. Deaf participant's language preference:

3. Interpreter Gender Preference (M/F):

4. Do Interpreters go through security?

Yes

5. Parking Information:

parking type

Street

Garage

Lot

parking Free

Yes

6. Metro Information:

Nearest Metro Stop
Metro Exit
Metro Line

7. Provide directions from major road or from Metro to building. For example, Take I-95 North from the Capital Beltway to your location, etc. We Must have directions for the Interpreter to get there promptly. Please include landmarks, road name, etc.

Directions are Required

8. Payment: When we receive your Interpreter Request via our online Interpreter Request form, you will be contacted to verify the request, and to make payment arrangements. We accept MasterCard, Visa, American Express, or Discover and you may use any of these for quick and efficient payment.