Home Services Survey - Reinhardt Leadership Team

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Reinhardt Leadership Team has been helping entrepreneurs and business owners since 2005 achieve their financial goals and personal success! Learn how to educate yourself with these recommended readings and personal growth tools. Find out how to make your dreams come true.

FOR YOUR HOME

Digital Phone Service
Local & Long Distance
Wireless
Energy
Television
Home Security & Automation
Internet
Technical Support
ACN View

home-survey.pdf
File Size:	470 kb
File Type:	pdf

Business Services

Phone Service
Energy
Merchant Services
Security & Automation
Satellite TV
Technical Support

Business Services

Home Services Survey

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Referred By *

Phone Number *

Email *

Home *

Rent Own

TELEPHONE

Do you have a home phone? *

Yes No

Do you have more than one line? *

Yes No

Current Provider? *

Bundled with: *

TV Internet Both

Do you have unlimited calling? *

Yes No

Do you make long distance calls? *

Yes No

International calls? *

Yes No

How much is the monthly bill? *

WIRELESS

Current Provider? *

When does your contract(s) expire? *

Last phone upgrade? *

How many phones do you have? *

How many minutes on your plan? *

What kind of phones do you have? *

Does your plan include unlimited data/texts? *

Yes No

Access Internet on your phone mostly at home? *

Yes No

How much is the monthly bill? *

INTERNET

Current Provider? *

Fast or Slow (or if speed known)? *

Bundled with: *

TV Phone Both

How much is the monthly bill? *

HOME SECURITY

Do you have a home security system? *

Yes No

Current Provider? *

Months left on contract? *

How much is the monthly bill? *

TECHNICAL SUPPORT

Current Provider? *

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

Yes No

Have you ever had a computer virus? *

Yes No

Amount spent on average computer repair incident? *

TELEVISION

Do you currently pay for TV? *

Yes No

Current Provider? *

Number of Receivers (TVs connected) *

Do you have: *

HDTV DVR Both

How much is the monthly bill? *

ENERGY

Current Electric Provider? *

Current Gas Provider? *

How much is your average Electric bill? *

Your Gas bill? *

Total

Total Monthly Amount *

Total Yearly Amount *

Submit

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