Sevice Application Form

Service Application Form

ADSL Service Informaiton

What are the reasons for visiting our web site today?

	Product Information
	Support
	Technical Information
	Purchase Products
	Competitive Information
	Other (Please Specify)

Please enter further details for the 'other' item you entered above.

How often do you visit our web site?

	Every Day
	Several times a day
	About once a week
	Several times a month
	About once a month
	Less than once a month
	This is my first visit

About how long do you spend browsing our web site on a typical visit?

	Over 40 minutes
	31 to 40 minutes
	21 to 30 minutes
	11 to 20 minutes
	5 to 10 minutes
	Under 5 minutes

The Web

When did you first start to use the World Wide Web?

How often do you browse the web?

	Every Day
	Several times a day
	About once a week
	Several times a month
	About once a month
	Less than once a month
	This is my first visit

In a typical week, how many hours do you spend surfing?

	Less than 2 hours
	Between 2 and 4 hours
	Between 4 and 6 hours
	Between 6 and 10 hours
	Between 10 and 20 hours
	Greater than 20 hours

For what reasons do you use the web? (choose all that apply)

	Work
	Entertainment
	Reference Information
	Computer News
	World/Local/National News

	Product Information
	Interactive Discussions
	Banking
	Gaming
	Other (Please Specify)

Please enter further details for the 'other' item you entered above.

How often do you use the web to gather information on products?

	Every Day
	Several times a day
	About once a week
	Several times a month
	About once a month
	Less than once a month
	This is my first time on the web

Have you ever purchased a product or service that your discovered on the web?

Yes

Not Yet

Have you ever purchased a product or service directly on the web?

Yes

Not Yet

Technology

What type of connection to the web do you have?

	28.8 Kbps or Less
	33 Kbps
	56 Kbps

	ISDN Line
	Cable or T1
	Don't Know

What type of operating system are you using?

	DOS PC
	Windows 3.X
	Windows 95
	Windows 98
	Windows NT
	Windows 2000

	Windows ME
	Macintosh
	Unix
	Linux
	Other

Please enter the operating system you are using?

What is your primary access point?

	Work
	Home
	School

	Web Cafe
	Store
	Other (please specify)

Please enter the other access point to the web?

What is your primary Web browser

	Netscape Navigator
	Microsoft Internet Explorer
	Mosaic
	America Online (AOL)
	Other (Please specify)

Please enter the other browser.

What other Web Browsers have you used?

	Netscape Navigator
	Microsoft Internet Explorer
	Mosaic
	America Online (AOL)
	Other (Please Specify)

Please enter the name of the other Browser you have used?

Which of the following features does your browser support?

	Graphics
	Tables
	Frames
	Java

	Javascript/JScript
	VBScript
	Don't Really Know

Web Site Quality
Please rate the content, look and feel of our web site pages.

	Excellent	Very Good	Good	Fair	Poor

Our Home Page

Our Technical Support Page

Our Product Information Pages

Our Contacts Page

Our Downloads Pages

Web Site Comparison
Please rate our web site in comparison to other web sites you may have visited

	The Best	Better Than Most	Average	Needs Improvement

Finding us on the Web

Navigating around our site

Our design

The information we provide

Revisit
How likely is it that you will

	Definitely	Likely	If appropriate	Not Likely	Definitely Not

Revisit our site

Recommend our site to friends or colleagues

Rely on the information on our site

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