Utility Survey

Your Name:
Your E-mail Address:
Your Home Phone Number:

What is your TV service: Cable
Fios
Satellite Dish
Broadcast

Do you have high speed internet in your home? YES NO
What kind of high speed internet? Cable DSL Other
Do you have more than one computer in your home? YES NO
If you have more than one computer, are they networked
(either to each other or a common internet connection)?
YES NO

How many phone lines do you have in your home?
Who do you buy your local phone service from?
Who do you buy your long distance service from?
Is your cellphone the only phone at the house? YES NO
How many cell phones do you have in your household?
Roughly when do the cellphone contract(s) expire?

Do you have a laptop? YES NO
Does your laptop have a wireless internet connection so you can use the internet virtually anywhere? YES NO

Have you looked at VOIP, Vonage, or other changes to your services? YES NO

Who is the Electricity Provider at your house?

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