Account Name
(Required)
Account Number (if known)
Call Info
Fax Direction
(Required)
Inbound
Outbound
Inbound => Faxes sent to WestFax
Outbound => Faxes sent from WestFax
Give us details about the fax(es) in question.
To Number
From Number
Date
Time (estimate ok)
Time Zone
Add
Remove
Provide enough examples as to identify the problem. You don’t need to include all faxes. Provide additional information in the Description area.
Description of issue
(Required)
Attachments
Drop files here or
Select files
Max. file size: 12 MB.
Please do not upload HIPAA Materials or documents containing ePHI or PII
Customer Contact information
Please provide a technical contact or customer contact who we can ask to test and verify deliverability
Name
(Required)
First
Last
Phone
Email
(Required)
Submitter Information
Submitter Name
(Required)
Phone
Email
(Required)
Additional notes
CAPTCHA