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* 1. What is your physical address?

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* 2. Which of the following options best describes the address above?

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* 3. What are your internet needs?  Please check all that apply.

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* 4. On a 1-10 scale, how would you rate your current internet service (1 being terrible service, and 10 being great service)?

1 5 10
i We adjusted the number you entered based on the slider’s scale.

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* 5. What internet service provider (ISP) do you currently have?

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* 6. How fast is your current internet connection, as stated in your service agreement with the ISP (in megabits per second)?  Note: this is often different from speeds experienced on a day-to-day basis. (Note: if speeds are less than 1 Mbps, please enter 1.)

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* 7. How fast is your current internet service, as experienced on a day-to-day basis (in megabits per second)?  If unknown, you can test your speed for free here. (Note: If speeds are less than 1 Mbps, please enter 1.)

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* 8. Does your internet plan include a cap or limit on service after a certain amount of data is used? 

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* 9. How much do you currently pay for your internet service (per month)?

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* 10. Internet Service to homes can cost anywhere from about $40/mo to around $200/mo.  Given this information, what is the most you would be willing to spend on internet service per month?

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* 11. If you would like local internet service providers to be able to contact you directly, please also include the following information.  (Information you provide will be supplied to local internet service providers for the exclusive purpose of determining the feasibility of providing internet access to your home or business.  Internet service providers are prohibited from using your information for any other purpose, or from sharing your data with any third party). 

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* 12. If we find an internet service provider (ISP) that could guarantee significantly better service to your home or business, would you be willing to put down a deposit of $100 with that company?  If you answer "yes," we will pass that information on to a local ISP.  

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* 13. Do you have any additional comments regarding your internet service?

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