PLEASE NOTE: THIS FORM SHOULD ONLY BE USED IF YOU ARE A *NEW* CLIENT, HAVE A SPECIFIC INTERPRETING REQUEST, AND HAVE NEVER USED OUR SERVICES BEFORE.

If you are a *new* client to DAS, please enter all pertinent information. Someone will contact you shortly.

Note:  * fields we definitely need to process you as a Client.

*Date Entered Into System 10/10/2025 9:41:02 PM  
* Client Name   
Contract No (if applicable)  
* Primary Contact Person  
Phone No  
Fax No  
* Email Address  
Alternate Contact  
Phone No  
Fax No  
Email Address  
Billing Contact   
Billing Contact Phone No  
Billing Address   
Specific Room/Info  
Billing City   
Billing State   
Billing Zip Code   
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