TELECOM SURVEY

Please fill my short survey. If I am able to save you money on your current bills I will contact you within 72 hours.

Name First Last
E-mail
Phone - (###) - ### ####
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
LOCAL / LONG DISTANCE SERVICE
Current Provider
My monthly bill is approximatly $ . Dollars Cents
Bundled With Internet Television Both
International calls Yes No
Long Distance Yes No
I am interested in unlimited calling Yes No
INTERNET SERVICE
Current provider
My monthly bill is approximatly $ . Dollars Cents
Do you recieve unlimited downloads Yes No
Type of service Cable DSL Dial Up Wireless Aircard
HOME SECURITY
Current Provider
I have home security service today I am interested in getting home security I am not interested in getting home security
WIRELESS SERVICE
Current Provider
My monthly bill is approximatly $ . Dollars Cents
Months left on my contract
Number of phones on my plan
Number of minutes on my plan
My phone was last upgraded
I like my phone I am interested in upgrading my phone I am interested in wireless for my lap top
DIGITAL PHONE SERVICE WITH VIDEO PHONE
Do you call anyone you wish you could see more often I am interested in Digital phone with Unlimmited calling
TELECOM SUMMARY
My total monthly bill is $ . Dollars Cents
My total yearly bill is $ . Dollars Cents
ELECTRICITY
My current provider is
My current rate/kilowatt is $ . Dollars Cents
NATURAL GAS
I think that rates will increase and would like to lock my price for 5 years I like to pay a varriable rate
THANKS FOR COMPLETING my SURVEY.