| First Name:
|
|
| Last
Name:
|
|
| Home Phone:
|
|
Best time to
Reach:
|
|
| Work
Phone:
|
|
Ext:
|
|
Best time to
Reach:
|
|
| Street Address
(Home / Business):
|
|
| City:
|
|
State:
|
|
| Zip Code:
|
|
| Email Address:
|
|
|
|
| Time Warner Cable
Subscriber:
|
|
| Are you requesting service for home or
business?
|
Home
Business
|
| Computer
Model:
|
|
| (e.g.: Compaq
Presario, Toshiba Equium 6230D, Macintosh Performa
6112)
|
| Network
Type:
|
|
| Laptop/Portable:
|
Yes
No
|
| Operating
system:
|
|
| Processor:
|
|
| Megabytes of RAM:
|
|
| Amount of free hard drive space:
|
|
| Do you have a sound card installed?
|
Yes
No
|
| Do you have an Ethernet card
installed?
|
Yes
No
|
| Do you currently have a dedicated telephone line
for data?
|
Yes
No
|
| Who is your current online service provider
(ISP)?
|
|
| What is the
speed of your connection at home?
|
|
| What is the speed of your connection at
work?
|
|
| How many hours
do you currently spend online each week?
|
|
| How many other
people in your household or business use the
Internet?
|
|
Business
managers, what type of
ROAD RUNNER
business usage interests you the most?
|
| If other,
please describe:
|
|
Which
ROAD
RUNNER feature interests
you the most?
|
| If other,
please describe:
|
|
What do you
generally use the Internet for?
|
| If other, please
describe:
|
|
How did you
hear about ROAD
RUNNER?
|
| If other,
please describe:
|
|
| What is your age?
|
|
| Gender:
|
Male
Female
|
| Feedback:
|
|
|
|