Assignment DetailsSubject/Topic*Provide a title for the class, meeting, or event. Recurring event?*Only select "Yes" if the event title above will repeat on a daily or weekly basis. If your schedule is more complex than that, such as a multi-day conference, please email the details to us directly (instead of using this form) at firstname.lastname@example.org. Yes No PLEASE NOTE: There is a 1‐hour minimum per assignment, charged in 15‐minute increments. In addition, for one-off (non-recurring) assignments, there is a 1-hour admin fee. Full Scheduling & Payment Terms are listed below.Date of Service* MM slash DD slash YYYY Start Date* MM slash DD slash YYYY End Date (if known) MM slash DD slash YYYY Start Time* : Hours Minutes AM PM End Time* : Hours Minutes AM PM Time Zone*(GMT -10:00) Hawaii(GMT -9:00) Alaska(GMT -8:00) Pacific Time (US & Canada)(GMT -7:00) Mountain Time (US & Canada)(GMT -6:00) Central Time (US & Canada), Mexico City(GMT -5:00) Eastern Time (US & Canada), Bogota, Lima(GMT -4:00) Atlantic Time (Canada), Caracas, La Paz(GMT -3:30) NewfoundlandRepeats Every* Select All Sunday Monday Tuesday Wednesday Thursday Friday Saturday Setting* School/Educational Business/Corporate Nonprofit Conference/Special Event Other Meeting/Event Platform*Tell us how the transcriber and/or consumer will join the event to access the audio & visual content. Zoom Blackboard Collaborate Google Classroom Conference call (phone) Transcriber(s) can be located* On-site Remote No preference What prep materials will be provided, if any?Please answer to the best of your knowledge so we know what to expect in advance, such as PowerPoint slides, textbook, lecture notes, meeting agenda, etc.Contact InformationHave you worked with us before?* No - I'll provide contact & payment info below Yes - please use same contact & payment info as before Yes - but I need to provide updated contact & payment info Your Name*Individual scheduling/coordinating the services First Last Your Phone*Your Email* Organization Your Role Service Coordinator Human Resources Event Coordinator Parent/ Advocate Consumer (individual using/accessing the services) Supervisor Billing Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Consumer Name(s) & Contact InfoIf you would like us to provide connection details in advance to the person(s) who will be accessing/utilizing the services, please provide their name(s) and the best way to reach them.Who referred you to us?We'll show our appreciation by adding an hour of free real-time transcribing services to their account. Review Our Terms:*FOR REMOTE TRANSCRIPTION: • Live audio is transmitted to the remote transcriber via phone, Skype, Zoom, etc. • The real-time transcript is streamed directly into the online meeting platform (if applicable) and/or to a unique web page, where it can be viewed on the Client’s own device. TypeWell will provide the Client’s unique transcript URL in advance. • After the event is over, the rough-edited transcript will be submitted to Client as a text file within 24 hours (or sooner, if requested). SCHEDULING & PAYMENT TERMS: • If you are a new client, pricing will be confirmed with you ASAP. • Events/meetings that are highly technical in nature or that are longer than 75 minutes may need a team of two transcribers, to ensure quality of service. • 1‐hour minimum per assignment, billed in 15‐minute increments. Assignments that run past the scheduled end time or require advanced login or extra setup/practice shall also be billed in 15-minute increments. • For one-off (non-recurring) assignments, there is a 1-hour admin fee in addition to the 1-hour minimum. • Client will not be billed for cancellations received at least 48 hours in advance by email (email@example.com) or phone/SMS (520-394-5186). • Rarely, there may be an extra admin charge if the event/meeting requires excessive technical assistance, travel time, or other administrative time. This will be determined once we receive all the details about your event, and will be agreed to by both parties in writing. • TypeWell will submit invoices by email on a monthly basis (or sooner for one-off events). Payments can be made by check or credit card, due within 30 days from the date of receipt of the invoice. • Late payments shall be subject to late penalty fees of 3% per month from the invoice due date until the amount is paid. I have reviewed and agree to the Scheduling & Payment Terms.Any additional questions or details you'd like to share with us?