Broadband Survey example 1

Was this survey sent to your home or office in paper form? *

Please enter your physical address: *

Do you subscribe to internet service? *

What form of internet service do you purchase? *

Who is your internet service provider? *

Does this provider meet the level advertised internet speed for the plan you subscribe? *

Have you ever purchased internet service from another provider at this same address? *

If Yes, please list the name of the previous provider(s)...

If you do not currently have internet service, have you attempted, in the past, to aquire service at this address but were unable to locate a providing company? *

In the past, has an internet provider tested access to the internet at this address? *

If Yes, please list the name of the service provider...

Was the internet connection test successful? *

If you do not subscribe to high speed internet, but it IS available, what is the reason you do not subscribe? *

If Other, please explain...

Any other comments about your internet or this survey?