Energy-Telecom Service Review
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Last Name:
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Street Address:
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Best way to contact me:
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Phone
Email
Referred by:
We will keep your information strictly confidential.
1. Cell Phone Service
Current Provider:
Select one
AT&T
Verizon
Sprint
T-Mobile
Nextel
Other
I am happy with my current provider
I am open to using different provider
My monthly bill is approximately:
$
Minutes on plan:
Select
Unlimited
30
200
400
450
500
550
700
750
900
1000
1400
1500
2000
2100
3000
4000
6000
Other
Months left on current contract:
Select
Prepaid
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
Number of phones on plan:
Select
1
2
3
4
5
More
I last upgraded my phone(s) approximately:
Select
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
More
months
I like my handset
I am interested in updating my handset
I am interested in a wireless card for my laptop
2. Local/Long Distances/International Service
Current Provider:
Select one
AT&T
Comcast
Verizon
Sprint
Other
Primary Phone Number:
(
) -
-
My monthly bill is approximately:
$
Bundled with:
Internet
TV
Both
Total Bill:
$
International calls included?
Yes
No
Long distance included?
Yes
No
I am interested in Unlimited Calling:
Yes
No
3. High Speed Internet Service
Current Provider:
Select one
Alltel
AOL
AT&T
BellSouth
Cablevision
CenturyTel
Charter Communications
Cincinnati Bell
Comcast
Covad
Cox
EarthLink
Insight
LocalNet
Mediacom
Qwest
Roadrunner
SBC
Time Warner
United
Verizon
Other
My monthly bill is approximately:
$
Type of service:
Cable
Dial-up
DSL
Wireless Aircard
Provider:
Bundled with:
TV
Phone
Both
4. TV Service
Current Provider:
Select one
Dish Network
DirecTV
CableVision
Charter Communications
Comcast
Time Warner
Other
My monthly bill is approximately:
$
Bundled with:
Internet
Phone
Both
Number of receivers:
Select
1
2
3
4
5
More
Months left on plan:
Select
Prepaid
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
I currently have:
HDTV
DVR
5. Home Security Service
I do not have home security services today, but I am interested in getting more information.
Current Provider:
Select one
ADT
FrontPoint
Brinks
Guardian
Other
My monthly bill is approximately:
$
6. Digital Phone Service with Video Phone
I am interested in Digital Phone Service (Unlimited Calling)
7. Gas and Electric Services
Current Provider:
Select one
PG&E
Edison
San Diego Gas & Electric Co.
Southern California Gas Co.
Other
My monthly bill is approximately (summer):
$
My monthly bill is approximately (winter):
$
I am open to using different provider
8. Comments