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* 1. Name

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* 2. Phone number

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* 3. Email

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* 4. Physical address in Jefferson?

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* 5. Mailing address, if different than physical address?

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* 6. Number of people living in your residence?

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* 7. Age of residents? (check all that apply)

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* 8. Do you operate a business at this address?

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* 9. Do you ever telecommute or remotely work from this address?

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* 10. What company do you use for internet now?

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* 11. What download internet speed do you get with your current provider? (Mbps = Megabits per second)

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* 12. What do you pay monthly for just internet service? (not including TV or phone)

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* 13. Do you subscribe to cable or satellite TV?

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* 14. Do you use streaming video services? (e.g. Netflix, Hulu, etc.)

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* 15. Does anyone in your home participate in online video gaming?

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* 16. How satisfied are you with the internet speed currently available to you?

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* 17. How satisfied are you with the reliability and service of your current internet provider?

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* 18. How satisfied are you with the current price you are paying for internet?

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* 19. What other comments would you like to share regarding the availability and quality of internet service available now in Jefferson, Maine?

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