1-800-442-3404
Home
Sitemap
Contact Us
Zodiac
Transciption
Dictation Option
Document Retrieval
Key Benefit
Special Offer
Signup Now !
Request for
Quick Quote
Client's Testimonials
Home
» Transcription Service Registration Form
T
ranscription Service Registration Form
Please provide information for all required fields.
*
= Required
Name
*
:
Company Name
*
:
Address
:
City
*
:
State
*
:
Zip
*
:
Phone
*
:
(000-000-0000)
Fax
:
Email
*
:
Website
:
Required for New Sign up
Credit Card Number
*
:
Expiration Date
(dd/mm/yy)
:
Security Code
:
Name on the card
:
Payment Method:
Billed Services Monthly
Credit Card Authorization
Preferred Dictation Method
Toll Free Number
Digital Voice Recorder
Preferred Document Delivery Method
Please call to discuss
DocDesk ( Preferred )
Fax
*
:
Email
:
* Additional 10 Cents / Page
Please Select:
Please charge the registration Fees $ 50.00 on my credit card (
Required on Credit card
)
I hereby authorize Zodiac Infotech to deduct monthly transcription service fees from my credit card mentioned above on 3rd of every month.
Yes, send me the Olympus DS-2 Digital voice recorder
No Charge, I agree to pay Min $ 125/- each user, each month for a period of 1 year.
I will pay $ 125.00 for DS-2.
I agree with transcription service sign up terms & conditions
Verification Code
:
Software Download
|
Vendor Registration
|
Become Sales Agent
|
Career
|
Resources
|
Disclaimer
|
Terms & Condition
