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* 1. First Name

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* 2. Surname

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* 3. Street Address

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* 4. Town

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* 5. State

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* 6. Postcode

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* 7. Email address

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* 8. Phone Number

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* 9. Please assist us by providing the following information - What age bracket are you?

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* 10. Please assist us by providing the following information - What gender are you?

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* 11. Are you able to make and receive voice calls inside your home?

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* 12. Are you able to make and receive voice calls outside your home?

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* 13. Are you able to send and receive SMS (text messages) inside your home?

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* 14. Are you able to send and receive SMS (text messages) outside your home?

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* 15. Are you able to use mobile data (Internet on your phone) inside your home?

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* 16. Are you able to use mobile data outside your home?

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* 17. Who is your mobile service provider?

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* 18. Do you have a current NBN or other Internet Service service at your home?

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* 19. Who is your Internet service provider?

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* 20. If known, is your NBN or Internet service?

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* 21. In terms of priority, what services do you need to access reliably?

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* 22. Would you be happy to be contacted by our Team if we feel we can offer a solution to your connectivity concerns?

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* 23. Can we assist you with a no-obligation bill review to determine if savings or more appropriate products may be available?

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* 24. Would you be happy to receive further information about this project or other services provided by Community Business Connect in the future?

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