Arizona Relay Service

1. Customer Information

Phone Number:
Email Address:
First Name:
Middle Initial:
Last Name:
Street Address:
City:
State:	AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY AA AE AP AS GU MP MH PR VI AB BC MB NB NF NT NS NU ON PE QC SK YT
Zip:
Check here if you want to be on the AZRS Mailing List    Yes    No Please include me on the Hamilton Relay Mailing List    Yes    No

2. Password + PIN

To make sure you are the only person who can make changes to your Profile, you should pick a "password" (secret word). Pick 4 to 10 letters and /or numbers. You also need to pick a "PIN" (secret number) to allow the CA to view your Profile when you make Internet Relay calls or when you use Remote Profile. Pick 4 numbers.

Password:	(pick 4-10 letters and/or numbers)
Pin:	(pick 4 numbers)

3. Making Relay Calls (check one) Every time I CALL Relay, I use...

If you live with a person who calls relay differently than you, contact Customer Service. *Section 3 does not apply when making calls using Hamilton Relay Internet.

Language Type:	English    Spanish    ASL
CA Gender Preference:	Male    Female

Voice Carry Over (VCO)
         Choose one VCO with Keyboard VCO without Keyboard
2 Line VCO
         Choose one w/ ASCII w/ Turbo Code
list your Voice or TTY call back number as Speed Dial number 1.

TTY
ASCII (Computer or TTY)
Hearing Carry Over (HCO)
Speech to Speech
2 Line HCO
list your Voice or TTY call back number as Speed Dial number 1.

Voice only user
         Choose one 711 800#

4. Answering Relay Calls (check one) Every time I ANSWER a Relay, I use...

If you live with a person who answers relay differently than you, skip this part.

TTY
(VCO users with a TTY answering machine should mark TTY)

Voice Carry Over (VCO)
         Choose one VCO with Keyboard VCO without Keyboard
Voice Phone
Hearing Carry Over (HCO)
ASCII (Computer or TTY)
Speech to Speech
Spanish

5. Long Distance Company

*If you leave this section blank, your bill will come from MCI**
*Section 5 does not apply when making calls using Hamilton Relay Internet

Please choose your long distance telephone company from the list provided. My long distance company is:

Select a Long Distance Carrier * Access One AZ AT&T Broadwing * Citizens/Frontier * Frontier Global Crossing * HTC Global Reach * IDT * ITT * LCI Lightyear/US Silent Network Long Lines * Marathon Communications MCI MCI/Worldcom McLeod NE Central Telephone Netlojix Opex LD * Pineland Long Distance Primus Telecom Qwest SBC Long Distance Sprint * Time Warner * TNCI * TTI National VarTec Fiveline Verizon/GTE Other
If Other:

* to set up a profile for this company you should already have them as your long distance telephone company

If you do not see your long distance telephone company on the list please provide the company name and the customer service number for the company.

6. For every relay call I make, I want...

Check the service you want with EVERY relay call you make.

Translator: Translate ASL to English
Slow Typing: CA will type slowly
No Background Sounds
Spell Check Off
No Abbreviations
No Tone of Voice

7. Speed Dialing

	Name (Example: Mom)	Location (optional) (Example: Work)	Phone Number (602-888-8888)	International Number?
1.				Yes
2.				Yes
3.				Yes
4.				Yes
5.				Yes
6.				Yes
7.				Yes
8.				Yes
9.				Yes
10.				Yes

8. Greeting

You can customize how the CAs identify relay to the person you are calling if so desired:

I want CAs to say my first name to the people I call. Name:

Example: "This is Arizona Relay CA 4444 with a call from Bob. Have you received a relay call before?"

I want CAs to tell the people I call I am:
      Deaf Hard of Hearing Speech Disabled Deaf/Blind

Example: "This is Arizona Relay CA 4444 with a call from someone who is deaf. Have you received a relay call before?"

(NE) Never explain how to use the relay to any person I call.

(NI) Never identify the relay to any person I call.

My Hello: (50 Characters including spaces): CAs will always greet the people you call this way:

Example: Hi, Bob here, How are you?

9. Notes Section

(50 Characters including spaces): Information for CA to have on every call:

Example: Calling Card # 508-555-5555 PIN # 5555

10. Restrictions

Select the types of calls that you do not want made from your telephone. If you check any on this list, you will not be able to make those types of calls through the relay. Please note long distance and directory assistance calls are free with Hamilton Relay Internet.

Long Distance
900/976
International
Directory Assistance
Operator Assistance

Thanks you for completing your Arizona Relay Customer Profile. If you have any questions about your Profile, please contact Customer Service. To print a copy of this form for your records, go to the File menu of your browser and select print before clicking on the Submit button.

If you are satisfied with your Profile, click Submit.