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?	Please Select 0 1 2 3 4 or More
Who do you buy your local phone service from?	Please Select AT&T/Southwestern Bell Verizon Other
Who do you buy your long distance service from?	Please Select AT&T/Southwestern Bell Sprint Verizon Other
Is your cellphone the only phone at the house?	YES NO
How many cell phones do you have in your household?	Please Select 0 1 2 3 4 or More
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?	Please Select TXU Energy Ambit Energy, LP. Amigo Energy Cirro Energy Commerce Energy Direct Energy, LP Dynowatt Econnergy Energy Company, Inc. First Choice Power, Inc. Gexa Energy Green Mountain Energy Company National Power Company Reliant Energy Spark Energy, L.P. StarTex Power Stream Energy Texas Power OTHER
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