1.Name

2.Phone number

3.Email

*4.Physical address in Jefferson?(Required.)

5.Mailing address, if different than physical address?

6.Number of people living in your residence?

1

2-4

5+

7.Age of residents? (check all that apply)

55 years and older

40-54

18-39

5-17

4 and younger

8.Do you operate a business at this address?

Yes

No

9.Do you ever telecommute or remotely work from this address?

Yes

No

*10.What company do you use for internet now?(Required.)

Consolidated Communications

Spectrum

Redzone

LCI

Tidewater Telecom

Dish Network

Direct TV

HughesNet

Phone data plan (Verizon, US Cellular, etc.)

Not sure

Other (please specify)

11.What download internet speed do you get with your current provider? (Mbps = Megabits per second)

10Mbps or less

11-25Mbps

26-50Mbps

51-100Mbps

More than 100Mbps

Not sure

12.What do you pay monthly for just internet service? (not including TV or phone)

$25-50 per month

$51-75 per month

$76-100 per month

$100-125 per month

Not sure

13.Do you subscribe to cable or satellite TV?

Yes

No

14.Do you use streaming video services? (e.g. Netflix, Hulu, etc.)

Yes

No

15.Does anyone in your home participate in online video gaming?

Yes

No

16.How satisfied are you with the internet speed currently available to you?

Completely satisfied

Somewhat satisfied

Not satisfied

Completely satisfied

Somewhat satisfied

Not satisfied

17.How satisfied are you with the reliability and service of your current internet provider?

Completely satisfied

Somewhat satisfied

Not satisfied

Completely satisfied

Somewhat satisfied

Not satisfied

18.How satisfied are you with the current price you are paying for internet?

Completely satisfied

Somewhat satisfied

Not satisfied

Completely satisfied

Somewhat satisfied

Not satisfied

19.What other comments would you like to share regarding the availability and quality of internet service available now in Jefferson, Maine?