You and Your Organization

Your Name

Organization

Title

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Referred By

Work Phone

Fax

E-mail

Credit Card Details

Credit Card #

Expiry 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).
Begin URL with 'www.'

Web Site URL

Enter a login and a password for this URL (8-14 characters). This password will allow you access to advanced setup features for webcallback.

Login

Password

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

Modifying Office Hours (Optional)

Note - WebCallback works 24 hours per day. If you answer your phones 24 hours per day or if you want your voicemail to answer the phone, you may ignore this section.

Modify Hours?

Yes No

Days & Hours

Finally EITHER give an alternative telephone number OR an electronic mail address

Alternative Number

Alternative Email