::ACD West Request Services::

Serving: Hillsborough, Polk, Pinellas, Pasco, Hernando, Manatee, Marion, Citrus, & Orange counties.

 

  • ACD west Request Services
  • ACD west Cancellation Request Services
  • ACD west VRI Request
  • ACD west VRI Cancellation

IMPORTANT!

Please be advised that all requests made through our internet service need to have a 48 hours notice. If you are requesting an assignment within the next two (2) business days (48 Hours), you must call our office to confirm receipt of the request. If your request is an emergency please call the office immediately or call our emergency number.

Please contact our office for more details or questions.

Please note: fields marked with * are required.

Interpreting Service Request Form

Date(s) for appointment(mm/dd/yy)* A value is required.Please enter date as mm/dd/yy.
Start time* A value is required.
Please remember to specify AM or PM
End time* A value is required.
Please remember to specify AM or PM
Appointment location name* A value is required.
Appointment location address* Street/apt A value is required.
City A value is required.
State A value is required.
County A value is required.
Zip A value is required.
On site contact name* A value is required.
On site contact phone* A value is required.
Person to see client* A value is required.
Reason for appointment* A value is required.
Deaf Client name (full name)* A value is required.
Special notes
(parking, directions, etc.)
Name of Requester (your name)* A value is required.
Requester phone number* A value is required.
Requester email* A value is required.Invalid email format.

Billing information

  
Company name* A value is required.
Company Address* Street/apt A value is required. A value is required.
City A value is required. A value is required.
State A value is required. A value is required.
Zip A value is required. A value is required.
Attention to* A value is required.

 

IMPORTANT!

If you are canceling an assignment within the next two (2) business days, you must call our office to confirm receipt of the cancellation. Please be advised ACD requires two (2) full business days (48 hours) notice on all cancellations. Less than two (2) business days notice will result in charges for original time scheduled. Please complete one form for each cancellation.

Please contact our office for more details or questions.

Please note: fields marked with * are required.

Interpreting Service Cancellation Request Form

Date(s) for appointment*
 (mm/dd/yy) 		A value is required.
Start time*: A value is required.
Please remember to specify AM or PM
End Time*: A value is required.
Please remember to specify AM or PM
Appointment location address* Street/apt A value is required.
City A value is required.
State A value is required.
Zip A value is required.
Reason for appointment* A value is required.
Deaf client name (full name)* A value is required.
Name of requester (person who made the original appointment* A value is required.
Cancellation requsted by
(your name)*		 A value is required.
Company name* A value is required.
Phone* A value is required.
email* A value is required.Invalid email format.

 

IMPORTANT!

Please be advised that all requests made through our internet service need to have a 48 hours notice. If you are requesting an assignment within the next two (2) business days (48 Hours), you must call our office to confirm receipt of the request. If your request is an emergency please call the office immediately or call our emergency number.

Please contact our office for more details or questions.

Please note: fields marked with * are required.

VRI Request Form

Date(s) for appointment(mm/dd/yy)* A value is required.Invalid format.A value is required.Please enter date as mm/dd/yy.
mm/dd/yy
Start time* A value is required.A value is required.
Please remember to specify AM or PM
End time* A value is required.A value is required.
Please remember to specify AM or PM
Contact name* A value is required.A value is required.
Contact phone* A value is required.A value is required.
Client* A value is required.A value is required.
Reason for appointment* A value is required.A value is required.
Deaf Client name (full name)* A value is required.A value is required.
Special notes
Name of Requester (your name)* A value is required.A value is required.
Requester phone number* A value is required.A value is required.
Requester email* A value is required.Invalid email format.A value is required.Invalid email format.
Requester SightSpeed™ user ID* A value is required.

Billing information

  
Company name* A value is required.A value is required.
Company Address* Street/apt A value is required. A value is required.A value is required.
City A value is required. A value is required.A value is required.
State A value is required. A value is required.A value is required.
Zip A value is required. A value is required.A value is required.
Attention to* A value is required.A value is required.

 

IMPORTANT!

If you are canceling an assignment within the next two (2) business days, you must call our office to confirm receipt of the cancellation. Please be advised ACD requires two (2) full business days (48 hours) notice on all cancellations. Less than two (2) business days notice will result in charges for original time scheduled. Please complete one form for each cancellation.

Please contact our office for more details or questions.

Please note: fields marked with * are required.

VRI Cancellation Request Form

Date(s) for appointment*
 (mm/dd/yy) 		A value is required.
Start time*: A value is required.
Please remember to specify AM or PM
End Time*: A value is required.
Please remember to specify AM or PM
Reason for appointment* A value is required.
Deaf client name (full name)* A value is required.
Name of requester (person who made the original appointment* A value is required.
Cancellation requsted by
(your name)*		 A value is required.
Company name* A value is required.
Requester SightSpeed™ user ID* A value is required.
Phone* A value is required.
email* A value is required.Invalid email format.