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1. Please describe your current voice and data service:
Number of Phone Lines:
Type of Data Connection:
Please Select One
Dial-up
DSL
Cable Modem
T-1
Ethernet
Fiber
Other
What speed is your current connection?
2. How much do you currently spend per month on Telephone & Internet Services?
$
per month
3. Are you interested in Fiber based services for your home or business?
Please Select One
Yes
No
Unsure
4. What would you pay for the same speed Internet service on Fiber?
Please Select One
More
Same
Less
5. What would you pay for faster speed Internet service on Fiber?
Please Select One
More
Same
Less
6. Would faster Internet speeds improve your current or future home or business opportunities?
Please Select One
Yes
No
Unsure
7. Would you change your service to a Fiber Network if it was available to your home or business?
Please Select One
Yes
No
Unsure
If No or Unsure, please tell us why?
8. Who are your current service providers?
Voice:
Data/Internet:
Phone System:
9. Is there anything you wish you could change about your current Telephone/Internet Service?
10. Do you have multiple choices for Voice/Data providers in your area?
Please Select One
Yes
No
Unsure
11. Who are the current provider choices for Voice/Data in your area?
Copper (Telephone/DSL/T-1):
Coax (Cable/Broadband):
Fiber:
12. Are you presently on a contract?
Please Select One
None
36 Month
24 Month
12 Month
13. What term/length of contract would you sign to get Fiber based services?
Please Select One
None
36 Month
24 Month
12 Month
14. Please provide any other comments or questions you would like answered
15. Please Enter your Home or Business Contact Information
Business Name
if applicable:
Contact Name:
Address:
City
State
MN
Zip
Phone:
E-mail: