*Name:
Company (if applicable):
Physical Address (no P.O. boxes):
*City:
*State: * Zip:
Phone:
*E-mail:
*Modem Brand and Model (please include speed):
*Ease of Connection:
*At what speed to you normally connect?
If you have used our technical support, was it helpful?
*How long have you been on the Internet (with us or other providers)?
If you have had other Internet service providers, please list them here:
*How satisfied are you with our Internet service (5 being very satisfied and 1 being
unsatisfied)? (Please note that phone line problems should not be considered
here. Please include phone line problems in the "Additional Comments" box
below.)
5 4 3 2 1
Additional Comments: