MLI 108 Survey Form

Providing Internet Services for the Upper 108 Corridor

Please answer the following questions if you are interested in Internet Service for your residence or business in the upper 108 corridor (ie., Cold Springs, Peter Pam or Strawberry communities). Your answers are an important part of us providing the ideal Internet services for your community. IMPORTANT: We need your response ASAP but no later than July 22nd, 2013


DO NOT HIT THE “ENTER” KEY TO MOVE TO THE NEXT FIELD. Hitting the “Enter” key will “execute” the Form and send it incomplete. USE THE “TAB” KEY TO MOVE TO THE NEXT FIELD! Then once you are done filling out the entire form, “click” the “Submit” button (at the bottom of the Form) to execute and send the Form. Thank you for your cooperation!


Owner Name:
Property Address:
City:
Zip:
Eamil:
Phone:
Rental?:YesNo
Occupant Name:

Owner’s Main or Billing Address (if different than above):

Address:
City:
State:
Email:
Phone:

Months property is occupied (rough estimate):

January 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Febuary 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
March 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
April 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
May 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
June 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
July 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
August 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
September 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
October 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
November 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
December 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Current Provider for Property:

Speed:
Monthly Cost
Satisfied:YesNo

What do you mainly use the Internet for at your 108 Property (check all that apply):

Web Surfing
Facebook
YouTube
Netflix
Video
Skype
Internet Phone (VoIP)
Telecommute
Remote Office
Work for Property
Other​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​

How soon would you want this installed?:

Now
3 months
6 Months
Next Year
Other​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​

What would be affordable to you?

$
per month

Would you use or occupy your property more if it had high speed internet service?

YesNo

Comments: