Contact Details

1. Name:
2. Company:
3. Address 1:
4. Address 2:
5. City:
6. State:
7. Zip:
8. Email address:
9. Telephone:

Current Telephone Services

1. Current Telephone Provider:
2. Current Monthly Expense:
1. Do you have internet services with this provider?

   
   
   

   1. Yes No
   
   
   Do you have a toll free number?

   
   
   

   1. Yes No
   
   
   Do you have any market expansion lines?

   
   
   

   1. Yes No
   
   
   Do you have a T-1 or Sip trunks for your telephone line?

   
   
   

   1. Yes No

Current Internet Services

1. Who is your current Internet Service Provider?:
1. What type of service do you have?

   
   
   

   1. DSL
   2. Cable
   3. T-1
   4. Fiber Optic
   5. Wireless Service Provider
2. What are the advertised speeds of your connection? (UP/DOWN)
3. What is the monthly charge for your internet services?

Local Network Information

1. What make and model is your internet router?
2. How many computers are on your network?
3. How many computers on your network connect wirelessly?
4. How many servers are on your network?