Business Services Survey

Reinhardt Leadership Team

Business Services Survey

* Indicates required field

Name *

First

Last

Referred By *

Company Name *

Phone Number *

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Are you a business owner? *

Yes No

How many employees do you have? *

Less than 3 3-50 More than 50

How many locations? *

One 2-4 5 or more

PHONE SERVICES

Number of business phone lines? *

Does your business have a fax line? *

Yes No

Does your business use Internet Services? *

Yes No

Who is your provider? *

Which of the following phone features are important to you? *

A service that allows me/employees to work remotely Traditional features, including Call Transfer Voice Mail Notification by Email State-of-the-Art Equipment Use of Existing Equipment

Current Phone Service Provider *

My monthly phone bill is approximately *

Months left on current contract *

How much is the monthly bill? *

BUSINESS SECURITY & AUTOMATION

Current Security Provider *

My monthly bill is approximately *

ENERGY

Current Electric Provider? *

Type of service? *

Electricity Natural Gas Both

My monthly bill is approximately $ *

Does your business use less than 185,000 therms per year? *

Yes No

Does your business use less than 3,000,000 kWh per year? *

Yes No

I am interested in the following: *

Natural Gas Electricity

TECHNICAL SUPPORT SERVICES

Do you have an IT person on staff? *

Yes No

When you do need support, are you able to get immediate service? *

Yes No

Do you perform a regular backup of all your information? *

Yes No

My monthly bill is approximately *

SATELLITE TV

How many stories does your building have? *

Is your building a multi-dwelling unit? *

Yes No

What type of business establishment do you own? (i.e. restaurant, bank, medical office etc.) *

Do you want extensive sports programming or international programming? *

Current TV Provider *

My monthly bill is approximately $ *

Months left on current contract *

Number of Receivers *

MERCHANT SERVICES

Do you accept credit cards? *

Yes No I plan to

Average ticket size *

I process over $3,000 per month *

Yes No

Total

Total Monthly Amount *

Total Yearly Amount *

Submit

Current Provider? *

Do you have unlimited calling? *

Yes No

LET US BE YOUR GUIDE TO FINANCIAL FREEDOM!