ASL Interpreting Request An Interpreter Appointment DetailsName of Deaf Consumer(Required) First Last Consumer's Date of Birth(Required) MM slash DD slash YYYY Name of Location(Required) Interpreting Location (Street Address)(Required) Street Address Address Line 2 City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Specific instructions for Interpreter upon arrival:Date and TimeDate(Required) MM slash DD slash YYYY Start Time(Required) Hours : Minutes AM PM AM/PM End Time(Required) Hours : Minutes AM PM AM/PM Requester InformationName of Requester(Required) First Last Email of Requester(Required) Requester Phone(Required)Email of Billing Department(Required) This is where the invoice for services will be sent.Onsite InformationOnsite Contact Name(Required) First Last Onsite Contact Phone Number(Required)Director's Name First Last Cost Center(Required) Additional information:Terms and ConditionsIMPORTANT(Required)By submitting this request, you agree to the terms below. Once the request is received in writing an email will be sent to your office to confirm your request. If your organization needs to cancel this request, AIDEAF Inc must be notified in writing no less than 2 business days before the scheduled appointment. The cancellation form must be filled out online at www.aideaf.com. All cancellations must be in writing and must have an explanation as to why the auxiliary aid is being canceled. If cancellation notification is not made, AIDEAF Inc will invoice for the total amount of your request. In the event that the AIDEAF Inc is unable to provide an interpreter, your office will be notified as soon as possible, no later than 1 business day before the scheduled assignment. I agree
