Our Goal - Making a Difference GET A COMPLIMENTARY WIFI ASSESSMENT Please fill out the following form for a Complimentary Wi-Fi Assessment of your community! First Name * Last Name * Email * Phone Number * State *---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming If you could please fill out the additional information below it will help us provide you with the most detailed quote possible. What is the size of your facility ? IL UNITS AL UNITS P/C / SNF BEDS CAMPUS SIZE (ACRES) IL COTTAGES No. of STAFF No. of Residents MEMORY CARE UNITS How spread out are your campus buildings? (Check all applicable) Clustered Mostly Villas and Indiv. Homes One Central Building and Villas Distributed and Spread out Hi-Rise Buildings only Low Rise Buildings Who is your current provider for Internet, Phone and TV? CONTRACT TERMINATION DATES: INTERNET PHONE TV Do you provide Internet, Phone and TV Service to residents or do they contract with provider individually? INTERNET: PROVIDE or CONTRACT We Provide Resident contract directly with provider PHONE: PROVIDE or CONTRACT We Provide Resident contract directly with provider TV: PROVIDE or CONTRACT We Provide Resident contract directly with provider What are the business reasons driving you to look at Wi-Fi, VOIP Phone or a new TV Provider? Please upload any documents here (Ex: Floor Plans)
