Broadband Speed Test Form
Name
Your answer
Street Address
Your answer
City
Your answer
Zip Code
Your answer
E-mail (for in-office contact use only)
Your answer
Is broadband available at this address?
If yes, do you subscribe?
If yes above, who is your internet service provider (ISP)?
Your answer
Are you satisfied with your broadband internet service?
What time of day did you complete the speed test? (Multiple tests done at different times of day will be particularly useful in understanding regional connectivity.)
Time
:
What type of connection was tested?
If using a cell phone, who is your network provider?
Your answer
What was your internet download speed? (Use www.speedtest.net to measure speed, list in Mbps)
Your answer
What was your internet upload speed? (Use www.speedtest.net to measure, list in Mbps)
Your answer
What was your ping? (Use www.speedtest.net to measure, list in ms)
Your answer
Comment: Any additional information about your service needs and/or experiences
Your answer
Today's date
MM
/
DD
/
YYYY
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