Interpreter Request Form
Please fill out the forms, and we will contact you soon as possible.
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Email *
Name of Requester *
BILLING ADDRESS *
DEPARTMENT *
COST CENTER
(for Hospital/medicall use only)
Email of Requester *
Phone Number of Requester *
Location/ Company Name *
ADDRESS:  send interpreter to, and details to help us find you i.e., 2nd floor, blue bldg park at back etc.
Date you need interpreter *
Time *
Name of Consumer(s) *
Language(s) *
Additional Information for the interpreter; location description or special needs of consumer etc..
Agreement
By submitting, I Agree Standard charge for an interpreter; $75 per hour with in Lee or Collier counties,
 2 hour minimum charge for each trip.  Must cancel within 24 hours. If your request is after hours on week ends or holidays, we will request approval for additional charge.
 
Hold Harmless Agreement Regarding Sign Language Interpreting
We________________________(Client or Individual) are the person, business or entity in need of sign language interpreting service (ASLI) is a professional Interpreting service, but That is possible for some miscommunication to occur. The Interpreters of ASLI strive to render accurate, precise interpretation, however situations and circumstances vary greatly and mis communication can occur.

Therefore, we _________________________(client or individual) agree to Hold Harmless form any liability for unintended miscommunications that can occur during the process of interpreting service provided by Agency of Sign Language Interpreters together with thier past and present representatives, employees, staff, and interpreters.
A copy of your responses will be emailed to the address you provided.
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