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Questions? Call Me.
Danielle Howley: 813-934-7913

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Once we have received this information we will begin building your new account.

Danielle Howley

Who Is Completing This New Account Request Form?


Please select an option.
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(xxx-xxx-xxxx format only)
(xxx-xxx-xxxx format only)
(xx-xxxxxxx or xxx-xx-xxxx only)
 
Do You Currently Have Another Account With AnswerFirst?
Please select an existing account option.
 
Who Would You Like To Include In Important Account Setup Communications?

 
Tell Us About The New Account We Are Setting Up
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(xxx-xxx-xxxx format only)
(xx-xxxxxxx or xxx-xx-xxxx only)
 
New Account Contacts
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You must have 1 billing contact
(xxx-xx-xxxx format only)
You must have 1 billing contact
(xxx-xx-xxxx format only)
You must have 1 billing contact
You must select an Emergency Contact.
 
New Account Security Information
Please select an account security option.
 
New Account Setup Information
(The rest of the information you'll be entering is for the account for which we'll be answering phone calls)
You must record the name of your company.

 
New Account Company Information
Monday - Friday

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Sunday

 
How Would You Like To Receive Your Invoices?



Please select an option.

Please add [email protected] and [email protected] to your personal and/or corporate email "white lists" to insure email is not marked as spam.

 
How Would You Like To Make Payments?




Please select an option.
Please enter a valid credit card number
(mm/yyyy format only)
Please enter the 3 or 4 digit Security Code for your card.
If you need to restart the authorization process, select "eCheck" as a payment option again.
All eChecks require online access to your bank account for account validation.
Please select the type of checking account.
(xx-xxxxxxx format only)
(xxx-xx-xxxx format only)
Info for prepay
 
New Account Agreements
-Health Care Providers. Health Care Providers who submit HIPAA transactions, such as claims or patient information, electronically are included. These providers include, but are not limited to: Doctors, Clinics, Psychologists, Dentists, Chiropractors, Nursing homes and Pharmacies.

-Health Plans. For HIPAA purposes, Health Plans include: Health insurance companies, HMOs, or Health Maintenance Organizations, Employer-sponsored health plans, Government Programs that pay for Health Care, like Medicare, Medicaid, and Military and Veterans’ Health Programs.

-Clearinghouses. Clearinghouses include organizations that process nonstandard health information to conform to standards for data content or format, or vice versa, on behalf of other organizations.

If still unsure, please click this link.

You must select an option.
By completing this account signup form, entering my name and selecting "Agree" below, I attest that I have read, understand and agree to immediately enter into and be bound by the Terms Of Service, including the information regarding the use of "call recordings" and AnswerFirst's "caller harassment" policy. I further attest that I have reviewed and understand all of AnswerFirst's Pricing, rates, charges and fees and that I am legally authorized to enter into this agreement and am authorizing AnswerFirst to begin billable services and my account setup, all of which I am financially responsible for.

By completing this account signup form, entering my name and selecting "Agree" below, I attest that I have read, understand and agree to immediately enter into and be bound by BOTH the Business Associate Contract and the Terms Of Service, including the information regarding the use of "call recordings" and AnswerFirst's "caller harassment" policy. I further attest that I have reviewed and understand all of AnswerFirst's Pricing, rates, charges and fees and that I am legally authorized to enter into BOTH of these agreements and am authorizing AnswerFirst to begin billable services and my account setup, all of which I am financially responsible for.

Please select an option.

Under Florida Statute §831.01 it is a felony to forge another's name via written or electronic signature.
You must select agree to submit this form.
 
 
 
 
New Account Setup Information
(The rest of the information you'll be entering is for the account for which we'll be answering phone calls)
 
New Account Emergency Contacts
(Typically the Owner or Management and last resort for any important communication about your account with AnswerFirst)
(xxx-xx-xxxx format only)
(xxx-xx-xxxx format only)
 
New Account On-Call Contacts
(Typically the person or people responsible for upkeep and maintenance of your on-call rotation, used as a last resort for missing information)
(xxx-xx-xxxx format only)
(xxx-xx-xxxx format only)
 
New Account Company Information
 
We will get you started with a basic messaging account.
Don't worry, you will have an opportunity to customize your account at a later date.

 
 
 
 
Customer Information
Customer ID:
Customer Number:
 
 
ServiceNow Information
            
 
Solve360 Information

 

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