REQUESTING OUR SERVICES

In order to request the services of an interpreter, please fill the fields below and submit.

If you require an interpreter within 48 hours or need inmediate assistance, please contact our office at 416-222-4622 or toll free number 1 866-639-2282

Please allow 24 hours for the processing of your request.

Client Login:


REFERRAL SOURCE INFORMATION
Company Name: *

Contact Person: *

E-Mail: *

Telephone: *

Fax Number: *

ASSIGNMENT INFORMATION
Language / dialect requested:

(If other, please specify)

Gender preference of interpreter:
Type of assignment:
1st Date:
 Start time:
 Duration:
Location
2nd Date:
 Start time:
 Duration:
Location
3rd Date:
 Start time:
 Duration:
Location
4th Date:
 Start time:
 Duration:
Location
5th Date:
 Start time:
 Duration:
Location
Would you like Exacta to confirm appointment with client?:
Would you like the confirmation of appointment by fax?:
CLIENT INFORMATION
Client name:
Telephone number:
Date of loss dd/mm/yy:
Claim number:
BILLING INFORMATION     Same as referral information
Company:
Contact person:
Address:
City:
Province:
Postal code:
E-mail:
COMMENTS/DETAILS: