Wisconsin Broadband Survey

* Required

Name* First Last If replying for a business, please indicate: Business Name Job Title # of employees

Physical Address (Include apt. or suite. No P.O. Boxes, please)* Street City   State: WI Zip Code Phone

Do you have broadband (High Speed Internet) service?*
What type of broadband?* Cable Modem   DSL   Satellite   Wireless Other   If you have any problems with your current broadband service (Check all that apply) Too slow for my applications. Too expensive for what I get. Too few broadband provider choices. Other	Do not have broadband service because:(Check all that apply)* Broadband is not available in my area. Have broadband access elsewhere. Broadband is too expensive. Dial-up internet suits my needs at this time. Do not own or use a computer that is suitable for broadband use. Do not need or want broadband service at this location. Other

Comments:

May we contact you if necessary?    Yes   No
If Yes, by	Email
	Phone	(Between 8:30 AM - 4:30 PM)
		If you are not able to complete the survey on line, please print this PDF form and then: Fax: (608) 266-3957 or Mail: Public Service Commission P.O. Box 7854 Madison, WI 53707-7854