Pay DHCC Invoice Online Request Interpreter If you need an interpreter within the next 24 hours, please fill out form below and then call us at:(610) 604-0452 to confirm. Interpreter Request Form Are you requesting an ASL Interpreter as...* A DHCC Customer (New & Existing) Community Interpreting Program - Family Gathering, Wedding, Funeral Etc. New & Existing DHCC Customers, please provide all detailed information below and our Customer Relations Coordination Team will be in contact with in one business day. If you are not contacted with in one business day please call 610-604-0450 or email ird@dhcc.org.Have you used DHCC services before?* Yes, We have used DHCC services in the past No, This is our first time using DHCC Services Requester Contact InformationIf you selected "New Customer" then please enter your contact information to review and to agree with our rates and policies prior to making interpreter request with DHCC.Name (Individual completing this form)* First Last Name of Company/Organization* Email (Individual completing this form)* Phone Number (Individual completing this form)* Is your phone number a Voice or VideoPhone number?* Voice VideoPhone Purchase Order / Cost Center Number (If Applicable) Company/Organization Billing Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Individual Billing Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Assignment DetailsCommunication Mode Options* ASL Onsite ASL Video Interpreting CART Date of Service* MM slash DD slash YYYY Interpreter Arrival Time* : Hours Minutes AM PM AM/PM Interpreter Start Time* : Hours Minutes AM PM AM/PM Interpreter End Time* : Hours Minutes AM PM AM/PM Additional Dates and TimesCompany Contact Person for Day of Service* First Last Company Contact Phone Number* Company Contact Email* Service Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Please enter the address where the interpreting assignment will take place. If this is a remote interpreting request, please enter "Remote" under Street Address and City then select "Pennsylvania" for State and enter your zip code. Location / Building Name* Name of Medical Professional (if Applicable) Free Parking?* Yes Additional Location InfoSecurity, Parking, etc.Assignment DescriptionDeaf/Hard-of-Hearing Client Name* First Last Type of Event*Wedding, Bar Mitzvah, Graduation Party, Funeral/Burial, etc If food is being served, is the interpreter welcome to join in the meal?* Yes No Description of Assignment*This includes all Deaf Attendees, Key Attendees and their rolesAdditional Information*Any information that would be helpful for ASL Interpreter for day of service. Video Platform / Meeting Link & DetailsIf you would like us to provide a Zoom Meeting Link please note hereName(s) of Requested Interpreter(s) Will this be recorded and used for promotional material, printed articles and/or video? Will it be shared with other individuals or entities not present during filming?* Yes No Is the press/media expected to attend or be present?* Yes No Community Interpreting Cancellation & Payment*Cancelation Policy Cancelation of interpreting services must be received by DHCC with two (2) full business days’ notice (not 48 hours) in between the date of cancelation and the date of service or payment of contracted hours will be required. Please note: if cancelation notice is sent to DHCC after regular business hours, it will not be considered “received” until the office re-opens. Bad Weather - If you notify DHCC that an event is canceled or a facility closes because of unusually bad weather that interferes with travel safety such as snowstorms, you will not be billed. Payment You may pay for interpreting services by check or credit card. You will receive an emailed invoice at the email address listed above for any travel expenses and the hourly charges. Payment of this invoice is due within 30 days from received date. Email any payment questions to Billing@dhcc.org . Yes, I agreeCommunity Interpreting Program Fees*The cost for each interpreter is $35.00 an hour with a minimum of a two hour assignment fee. Time scheduled after 2 hours is billed in 15-minute increments. Interpreter travel expenses may be billed. Roundtrip mileage will be charged at the allowable IRS mileage reimbursement rate. Additional travel may include tolls, parking, public transit, or cab fare. Yes, I agreeAgreement*I agree to pay $70 for the first two hours per interpreter, and additional time at the rate of $35 per hour per interpreter. I agree to pay travel expenses, including tolls, parking fee, and mileage at the current IRS rate for each interpreter. I understand that if I cancel the interpreters less than two full business days before the assignment (i.e. cancel later than Wednesday for a Saturday assignment), I will still be charged for the full amount of time I requested the interpreter(s). I agree to pay this fee. Yes, I agreeAgreement*I have reviewed and agree to DHCC invoicing and cancellation policies; including but not limited to being invoiced at the requested timeframe with a 2-hour minimum; any additional time will be billed in 15-minute increments. Please see Invoicing and Cancellation Policy at https://dhcc.org/terms-privacy/interpreting-services-policies/ or request full agreement from the Customer Relations Team. Yes, I agreePhoneThis field is for validation purposes and should be left unchanged.
