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What is your name, address, and phone number :
   
 
 
 
What type of phone is the phone number you gave above?
 
Home Phone
 
Cell Phone
 
 
 

Who Is YOur Cell Phone Carrier?
 
ATT
 
Verizon
 
Sprint
 
T-Mobile
 
Straight Talk
 
Net 10
 
Tracfone
 
Virgin Mobil
 
Go Phone
 
 
 
 
   
My Cell Phone handset is a ______________ (example: iPhone 4)
   
 
 
 
My present cell phone is a (Example IPhone 4)
   
 
 
 
It uses the following service
 
3G
 
4G
 
Otherr
 
I don't know
 
 
 
My signal strength inside my house is
1 Bar ____ 2 Bars ____ 3 Bars ____ 4 Bars ____ 5 Bars ____

 
1 Bar
 
2 Bars
 
3 Bars
 
4 Bars
 
5 Bars
 
 
 
How often do you conduct surveys?
 
Weekly
 
Monthly
 
Quarterly
 
Annually
 
 
 
Have you changed your cell phone service because of poor reception?
   
If so, who was your old cell phone carrier? ________________
   
 
 
 
Describe any special method you use to improve cell reception in your home:
   
 
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