Businesss Wi-Fi Survey

Interest Questionnaire – Government/Business/Non-Profit

Please print this page on your printer, fill in the following information and FAX or mail to the town.

Entity Type (Check One): Residential
Home-Based Business
Business
Town
County
Educational
Medical
Non Profit

Entity Name (if not a private residence) ______________________________________________________________
Contact Name ___________________________________________________________________________________
Street Address ____________________________________________________________________________________
Phone _________________ Fax __________________ Email ____________________________________________
# of Employees in the area: Full Time _____Part Time_____
Number of locations in the area? ________ Outside the area? ______

TELECOMMUNICATIONS PROFILE:

Please answer the following questions for all your locations (either separately or grouped together).
# of Voice lines _____ #Fax lines _____ #Data lines (computer/modem) _____ # Computers _______
Your Internet Provider: _____________________
Do you have any dedicated connections (data lines) to other locations? Yes No Type: _____________________________________________________________

Is Internet access critical? Yes No

Monthly cost of dedicated computer line: $ ________ Monthly cost for Internet services: $ __________

Type of current Internet Connection? (check as many as necessary). Note: if you have a dial up Internet connection, you will hear “scratchy noises” as the connection is being made. All other types of connections are silent.

Dial-Up    Cable    Modem    Frame Relay    ISDN    DSL    ATM     T-1   DS-3    Wireless
Satellite

If you currently do not have a high speed Internet connection (i.e., faster than a dial-up modem connection), how much additional monthly fee would you pay for Internet access that is 10 times faster than a current dial-up connection?
$15
$25
$50
$75
$100
$300
Greater than $300

Check off how much bandwidth do you feel your location(s) needs now, and how much do you think you will need in 12 to 18 months:

Now:

56 Kilobits per second (Dial-up)
56 Kbps (Dial-up)
256 Kbps (DSL) 256 Kbps (DSL)
512 Kbps
1.5 Mbps (T-1)
___# of T-1s
10 Mbps

In 12 to 18 Months:

56 Kilobits per second (Dial-up)
56 Kbps (Dial-up)
256 Kbps (DSL) 256 Kbps (DSL)
512 Kbps
1.5 Mbps (T-1)
___# of T-1s
10 Mbps


Which Internet services would be valuable to you? (check all that apply):
Faster Speed
Training
Video Arraignment
High-speed data transfer (data, music, etc.)
GIS data sharing
E-mail
Video Conferencing
Tele-medicine
Link multiple physical locations
Research/Surfing
Data Backup
Web Hosting/e-commerce
Distance Learning
Local and Long Distance Phone service over Internet

We would like to know more about what problems you have because you do not have high-speed access. How would you use a high-speed connection if it were available? Please be specific. Use additional pages if necessary.

Thank You! -- Town of Superior High Speed Internet Committee

Key Wi-Fi Terms