Telephone Query

Telephone Number displayed on the Caller ID: ____________________
Name as it appears on the caller ID: ____________________________

Name of Caller: _________________________________________________
Telephone Number: _______________________________________________

Name of Supervisor: _____________________________________________
Telephone Number: _______________________________________________

Name of Company: ________________________________________________
Type of Company: ________________________________________________
Address of Company: _____________________________________________
_________________________________
Company Telephone Number: _______________________________________
Company Federal Tax ID Number: __________________________________
Company State Tax ID Number: ____________________________________
Company Website: ________________________________________________

Do You Subscribe to the Federal Do Not Call Registry __ Yes __ No
Do You Subscribe to the State Do Not Call Registry? __ Yes __ No

If the call was a Robo/Computer generated call (pre-recorded
sales pitch) – Do you (the Caller) have written permission from
me that authorizes you to call me? _____ Yes _____No

What is the purpose of your call: ________________________________
__________________________________________________________________
__________________________________________________________________

Do you understand I will provide, nor confirm any personal information:
_____ Yes _____No

Are you a registered/licensed Telemarketer? _____ Yes _____No

What process do I follow to activate the “Opt-Out” option so that
you never contact me again. _____________________________________
__________________________________________________________________