Cust acqflyer horfullpage_nologo

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Cust acqflyer horfullpage_nologo

  1. 1. Name_ ____________________________________________________Connecting you, your family, Address____________________________________________________ City _________________________State_____Zip Code_____________your friends... your LIFE! Email____________________________Phone #___________________  Rent  Own 1 Local/Long Distance Service 5 Mobile ApplicationCurrent Provider___________________________________________________________________ Do you make long distance or international calls on your mobile phone? Yes  No  Primary Phone Number _____________________________________________________________ Are you interested in saving money on your mobile phone bill? Yes  No  My monthly bill is approximately $___________________________________________________ • Bundled with:  Internet  TV  Both 6 TV Service • Total Bill $_____________ Current Provider___________________________________________________________________International Calls:  Yes  NoLong Distance:  Yes  No My monthly bill is approximately $___________________________________________________I am interested in Unlimited Calling:  Yes  No • Bundled with:  Internet  Phone  Both Number of receivers______ Months left on contract ______ 2 High Speed Internet Service I currently have  HDTV  DVR Current Provider___________________________________________________________________ 7 Home Security & Automation ServiceMy monthly bill is approximately $___________________________________________________ Current Provider___________________________________________________________________ • Type of Service:  Cable  Dial-Up   DSL Wireless Aircard (Provider_______) • Bundled with:  TV  Phone  Both My monthly bill is approximately $___________________________________________________ I am currently a:  Homeowner Renter  3 Digital Phone Service  do not have home security service today, but I am interested more information. I  am interested in Home Automation service. I you call anyone who you wish you could see more often? Do am interested in Digital Phone Service (Unlimited Calling) I 8 Computer Support 4 Wireless Service Current Provider___________________________________________________________________ Do you perform a regular backup of all your files? Yes   NoCurrent Provider___________________________________________________________________ Have you ever had a computer virus? Yes   No  I love my current provider  I am open to using a different provider Amount spent on average computer repair incident $________My monthly bill is approximately $_______ Minutes on plan______ Please select the type of computer support services you’ve used in the pastMonths left on current contract ______ Number of phones on plan ______  Friend or Family Member  Remote ServiceDo you currently have a texting plan?  Yes  No  National Provider  Self-helpData Plan included?  Yes  NoI last upgraded my phone(s) approximately: ____ Months ____ Years 9 Energy  like my handset I  am interested in service without a contract I Current Provider___________________________________________________________________  am interested in updating my handset I or credit check Type of Service  Natural Gas  Electricity  Both  am interested in a wireless card for my I laptop My monthly bill is approximately $____________ I am interested in the following: (check all that apply)  Residential Electricity  Residential Natural Gas  Business Electricity  Business Natural GasPERSON WHO INVITED ME: Total Monthly Bill Amount $__________________COMMENTS: Total Yearly Bill Amount $__________________ ©ACN Opportunity, LLC 2012 HSSEnergy_W_CC_041112

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