1.
First Name
4.
Last Name
2.
Your Town
5.
Your Zip
3.
Your Email
(put N/A if you don't have one)
NOTE: Equipment and Setup will cost approximately $195 per home. This is required to be on the network.
7. How many computers do you have at
your location?
1
2
3
4
5
6
7+
8. Are your computers
networked ?
Yes
No
N/A
(leave at N/A if you only have 1 computer)
9. Do you have a Laptop, Desktop or
Both/Mix?
Laptop
Desktop
Both/Mix
10. What OS(es)/Devices will need the
Internet? (check all that apply)
Windows:
95 |
98/ME |
NT4 |
2000 |
XP |
Win
Server OS |
I have no idea what Windows
MAC:
OS X
|
9 |
8 |
Older than 8
*nix:
Any
Linux |
Unix |
Solaris |
AIX |
FreeBSD |
Other *nix
Other:
Game Console |
Other Not Listed
11.
Phone
12.
Address (E911 )
13.
Closest Road
17. Can you see your
neighbor?
Yes
No
18. Would you be willing to be an
access point ?
Yes
No
Customers who are
access points have no equipment to buy, pay $10 less for monthly
service, and have an extra antenna on the outside of their property
as well as a small equipment box. Sometimes we need to turn a
customer into an access point to get their neighbors online.
If we turn you into an access point after you are setup, we will
refund you your equipment purchase price and begin the new rate at
the time you become an access point.
19. Did you respond to
previous surveys about Internet?
Yes
No
20 . Do you have a laptop
with wireless capabilities?
Yes
No
Don't know
21 . Do you want to use
your wireless at this location?
Yes
No
Don't have wireless
22 . If you have more than
one computer that you want to use on the internet and they are not
networked, which of the following items do you want to do to resolve
this? (Leave all at default if you don't have more than one
computer you want on the internet)
Please select one from each dropdown to complete the sentence:
Wiring Options
Wireless Cards Options
n/a - Wireless or Only One PC
Wiring is all set,
Please install wiring, ###
n/a
I have wireless cards that will be installed
I have wireless cards, but they need to be installed ###
Please sell me wireless cards which I will install them
Please sell me wireless cards and install them ###
Wireless Router Options
n/a - Only have one computer
and I have a Wired Gateway, please configure it
and I have a Wireless Gateway, please configure it
and Please sell me a Wired Gateway and configure it
and Please sell me a Wireless Gateway and configure it
Please Instead sell me Separate Individual Devices for Each Computer - No Network ***
NOTE1: Items with ### mean you will be charged hourly rate for labor plus materials.
NOTE2: Item with *** means extra equipment charge per computer, but
still no installation fees. (not recommended)
23 . Do you want
email
addresses with us or do you have your own domain?
I need email from you
I have my own domain
If you have your own domain (www.yourcompany.com) , what is it?
If you have your own domain, which registrar did you purchase
it from?
If you need email from us, how many addresses do you need? (2
are free)
None
1
2
3
4
5
6
More
What email addresse(s) would you
like?
@wirelessvt.net
@wirelessvt.net
(please also list
alternate choices - ex: 1-john, 2-johnv)
(Please list all addresses you
would like based on the number of addresses you want in that box
above)
(Email address choice is first-come first-served so fill this out
now to secure your choices of addresses!)
24. Do you want to have a
web site with us?
No
My domain will stay Hosted somewhere else
I want it hosted under my email name
I want it hosted under my domain name
What is a web site?
25. Do you want us to purchase a domain name for you?
Yes
No
(@$10.00 per year for 3 years)
If so, what name(s) do you want?
26. Do you live in your
location all
year round or just for part of the year?
All Year Long
Part of the Year
If you live
here part time, do you have your power turned off when you are not
here?
Yes
No
I live here all year long
27. When would you ideally want to
start having the internet connection?
As Soon As Possible
January
February
March
April
May
June
July
August
September
October
November
December
28. Are you surrounded by trees and
can see nothing (no mountains, no neighbors...just trees)?
Yes
No
29. Do you have
Anti-Virus on your
Computer?
Yes
No
If so, what brand?
If you do not have Anti-Virus, would you like us to install a
free one on your PC / Unix during installation?
Yes
No
30 . Would you like a
Firewall Gateway ?
Yes
No
(Free Setup! - We recommend this for everyone)
This adds a level of protection between you and
your neighbors from Viruses and Intrusions - maximum price is $50
for the device, one-time fee. If you get a Router from us for your
network, Question #22 (router is required for network), it is
included so indicate NO here. If you have your own router for
your network, the firewall is probably included.
31 . Are you interested in using
VoIP
service? (Respond NO if you don't know what it is)
Yes
No
If so, do you have a specific provider in mind?
Yes
No
Who?
32 . Would you like us to contact you by
phone immediately regarding anything on this form or our service?
Yes
No
(indicate below what your questions or concerns are)
Are there any comments,
concerns or questions you would like us to answer for you?