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Contact Information
Customer Name
Email Address
Contact Phone Number
Phone Number of Premises
Company Name
Address
Suburb/Town/City
State
Postcode
Please complete the following questionnaire
(if applicable)
Is your office networked?
-- choose one --
yes
no
How many computers do you have?
-- choose one --
1-5
6-10
11+
Do you have more than one office?
-- choose one --
yes
no
Do you need a Secure connection (VPN) between your offices?
-- choose one --
yes
no
How do you currently access the internet?
-- choose one --
Dial Up Modem
Permanent Modem
ISDN
Other
If other, please specify
Do you have a website?
-- choose one --
yes
no
Website URL (if applicable)
Do you have your own mail server?
-- choose one --
yes
no
Additional Comments
In this section:
Business Broadband
Premium xDSL
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Features
Inquiry
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Wireless Broadband
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