Message Receiver Change Form for South Dakota One Call
*= Required Field
*CDC:  
*Company Name:  
*Person Submitting:  
*Phone No.:   e.g. 1115552222
 
Primary Receiver Location Information:
Note: If your company will be receiving tickets at more than one location, then this page must be duplicated for each receiver location.
 
*Contact Name:  
*Phone:   e.g. 1115552222
Fax:   e.g. 1115552222
*Street Address:  
*City:  
*State:      *Zip code:
 
*Normal Working Hours for this Office
(Mon - Fri): 		  to
Normal Working Hours for this Office
(Sat - Sun): 		  to
 
Primary Receiver Device Information:
*Email:    |  Fax:   |  Printer:   |  PC Software:   |  Voice:
E-mail:  
Primary Receiving Device Phone Number
(if not listed as email above):		   e.g. 1115552222
Baud Rate:  
 
Voice Message Receiver Information(incurs additional charge):
 
Normal Working Hours:
Do you wish to receive a voice message from the Call Center (in addition to the regular message transmission) for an emergency message?
1. Emergency?   Yes:   |  No:   If Yes, Phone Number: e.g. 1115552222
2. Dig Ins?   Yes:   |  No:   If Yes, Phone Number: e.g. 1115552222
 
After Normal Working Hours:
Do you wish to receive a voice message from the Call Center (in addition to the regular message transmission) for an emergency message?
1. Emergency?   Yes:   |  No:   If Yes, Phone Number: e.g. 1115552222
2. Dig Ins?   Yes:   |  No:   If Yes, Phone Number: e.g. 1115552222
 
*Additional Instructions:
Completion Day: Completion Time: Completion Date: