First Name:
Last Name:
Title:
Company:
Address:
City:
State:
Zip/Postal Code:
Country:
Phone:
Extension:
Fax:
E-mail:
1. How many computers are on your network?
...
1-10
11-20
21-50
51+
N/A
2. What is your current level of Internet connectivity?
...
Dial-Up
ISDN
xDSL
T1
T3
Other/Not Sure
Not Connected
3. Are you satisfied with your current Internet provider
...
No
Yes
Don't have one
4. Who is your provider?
5.What is your timeframe for Internet access to your LAN?
...
ASAP
Less then 45 days
Less then 90 days
Less then 120 days
More then 120 days
6. What is your monthly budget for Internet connectivity?
$
Other Comments
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