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Home Services Survey



Cell Phone
Cell Phone
Home Phone
Home Phone
High Speed Internet
High Speed Internet
Television
Television
Home Security
Home Security
Video Phone
Video Phone
Summary
Summary

Cell Phone

Current Provider
I love my current provider
I am open to using a different provider

My monthly bill is approximately $          Minutes on plan
Months left on current contract     Number of phones on plan
I last upgraded my phone(s) approximately: Months    Years
I like my handset
I am interested in updating my handset
I am interested in a wireless card for my laptop

Home Phone

Current Provider
Primary Phone Number
My monthly bill is approximately $
Bundled with: Internet    TV    Both
Total Bill $
International Calls: Yes    No
Long Distance: Yes    No
I am interested in Unlimited Calling: Yes    No

High Speed Internet

Current Provider
My monthly bill is approximately $
Type of service:
Cable    Dial-Up
DSL      Wireless Aircard



Bundled with:
TV    Phone    Both

Television

Current Provider
My monthly bill is approximately $
Bundled with: Internet    Phone    Both
Months left on current contract Number of receivers
I currently have HDTV    DVR

Home Security

Current Provider
My monthly bill is approximately $
I do not have home security service today, but I am interested in getting
a home security system and would like more information.

Video Phone & Digital Phone Service

Do you call anyone who you wish you could see more often?
I am interested in Digital Phone Service (Unlimited Calling)

Summary

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– John F. Kennedy
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