Broadband Survey

Do you currently have Internet service at your home? Do you currently have Internet service at your home? Yes No

If you selected Yes, who is your current Internet provider If you selected Yes, who is your current Internet providerFrontierHughesNetProgressive BroadbandNot Applicable / Don't have internet serviceCharterAT&TSpirit BroadbandOther

Are you satisfied with the speed and reliability of your Internet service? Are you satisfied with the speed and reliability of your Internet service? Yes No

If you are not satisfied, please explain why:

Number of people living in household: Number of people living in household: 1 2 3 4 5 or more

Does anyone in the household have health needs that high-speed Broadband would help? (connecting online with doctor's office or the V.A., telemedicine, online prescription refills, medical monitoring, etc) Does anyone in the household have health needs that high-speed Broadband would help? (connecting online with doctor's office or the V.A., telemedicine, online prescription refills, medical monitoring, etc) Yes No

If you selected yes, please explain:

Is anyone living in the household disabled? Is anyone living in the household disabled? Yes No

If you selected yes, please explain:

Are there students in the household that need reliable, high-speed Broadband for schoolwork? Are there students in the household that need reliable, high-speed Broadband for schoolwork? Yes No

If you selected yes, please explain:

Does anyone in the household need reliable, high-speed Broadband to work from home? Does anyone in the household need reliable, high-speed Broadband to work from home? Yes No

If you selected yes, please explain:

Do you run a business from home or participate in farming activities (crops, livestock, etc.)? Do you run a business from home or participate in farming activities (crops, livestock, etc.)? Yes No

Are you interested in a high-speed Broadband service from Ben Lomand Connect? Are you interested in a high-speed Broadband service from Ben Lomand Connect? Yes No

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