Community Connectivity Survey Name* First Last Address* Street Address City State / Province / Region ZIP / Postal Code Email PhoneDo you currently have internet at your home* Yes No Please choose the type of internet connection you use: Wireless Wireline Satellite Cable Other If you know your current speed package please enter that below: If you are comfortable please tell us what you currently pay monthly for your internet service: Would you be open to switching to a new internet service provider?* Yes No If you were to switch providers, which plan would you be interested in switching to?* 100 Mbps/100 Mbps for $50/month 200 Mbps/200 Mbps $70/month 1 GB/1 GB for $90/month I would not switch providers or do not want internet Which features of internet is most important to you?* Price Connection Speeds The provider
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