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New Customer Registration

If you are a Deaf/Hard of Hearing customer, please use this form. If you are an Interpreter or Captioner, please use this form.

Name of the Person Submitting this Request

Name *
Name
Address *
Address
Phone *
Phone
Service Needed:
Location Address: *
Location Address:
Point of Contact Phone: *
Point of Contact Phone:
We offer a variety of payment options including check, credit card (Mastercard, Visa, American Express), and P-Card, Payable upon receipt of invoice through our secure site Gridcheck.com Billing Contact Name:
Billing Phone: *
Billing Phone:
Billing Address: *
Billing Address:
I agree to all the Terms and Conditions listed below and I am authorized to approve payment. *
Terms and Conditions: Submitting this form begins your registration process. It does not guarantee services. When your registration has been received, we will also email you our Service Agreement. Hawaii Interpreting Services respects the security and privacy of its customers and service providers. We will never share your information without your permission. By submitting this form you authorize us to create your account with Gridcheck.com, our secure scheduling and management site.