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First Name:
Last Name:
Title:
Your Company:
Email:
Your Address:
Your City:
Your State:
Zip Code:
Phone #:
Fax:
How many personal
computers are in use
in your offices?
1-4
5-14
15-30
31-62
63-126
more than 126
Who is your current ISP?
At what speed are you connected to the Internet?
Dial-up
ISDN
Other Broadband
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Your business use of the Internet is:
exploding
heavy
moderate
light
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