You and Your Organization

Your Name

Organization

Title

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Work Phone

Fax

E-mail

Credit Card Details

Credit Card #

Expire Date (mmyy)

Name on Card

Card Issuer

Callback Site Details

This message will be displayed on the call form that prompts the customer for their phone number

Message for Call Form

Please enter the international code and telephone number to receive WebCallback calls (e.g. USA is 1, France is 33, etc.)

Callback Country Code

Callback Phone Number

Fill in the following field if your call center can handle multiple simultaneous calls

Number of calls

Enter the URL of the site which you wish to use the WebCallback service from (e.g. www.xyz.com)

Web Site URL

You may restrict calls so they only come from a single country. For example, to restrict calls to within the USA, enter country code 1.

Restrict International Calls?

Yes No

Allow Only Country Code

Office Hours (Optional)

Note - you may skip this section and create your web page immediately.

WebCallback works 24 hours per day. If you don't have voicemail or an answering service when your offices are closed, you may send calls to an alternative number, take an e-mail message, or sign up for GlobalPhone voicemail. If you want one of these options, select YES below, then enter your opening and closing times. These 24-hour times must be in Eastern Time, which is currently 0946

Modified Service Outside Office Hours?

Yes No

EST Opening Time

EST Closing Time

Using 1 for Sunday through 7 for Saturday list any days your offices are closed so your web site should not call people (example -- Saturday and Sunday would be "17" or "71")

Days Closed

Finally EITHER give an alternative telephone number OR an electronic mail address OR select GlobalPhone voicemail service

Alternative Number

Alternative Email

GlobalPhone Voicemail

Yes No