Broadband for the White Peak

To get us started, we need to build a list of potential locations (homes, businesses etc) where there might be a demand for Broadband.

We will collate the information and supply it to the East Midlands Development Agency and their agents, and to other bodies who might provide funding. We will not publicise any individual details - if we do publicise the results of this registration process it would only the total number of each type of potential user - we would not give anything more detailed. We will not sell this information to anyone else.

We will use the contact details to keep you up to date on the project, and to ask for further information if we need it.
Contact Information

Contact Name:
 

Address:

 
Postcode:
 
Telephone number at this location:

If we needed to check anything on this form, would it be OK to call you? You can call me on the number above
You can call me on this other number:
Please don't call me
(Even if you don't want us to call you, we would still appreciate knowing the phone number in case we need to get BT to cross-reference our registrations against their information)
What type of location is this?
Please tick relevant box(es) to describe this location
 
A factory or workshop
An office
A farm
A shop
A B&B, Pub, Hotel, or Hostel
A house, flat or other living accommodation
If so, please also tell us the following:
  There are people (excluding pre-school children) in the household
  How many of these people (if any) fit into the following categories?
  run a business (or work on a self-employed basis) from here
  work most of the time at home and some of the time at an employer's site elsewhere
  work some of the time at home and most of the time at an employer's site elsewhere
  follow a formal education course, and do some or all of the work at home
Other type of location - please give details
   

Do you currently use the Internet from here?
(Please choose ONE option)
   
YES - I/We currently connect to the Internet from here:
Connect to Internet by modem* which shares the main (voice) phone line at this location
Connect to Internet by modem* which has a separate phone line (or shares with fax line)
  * A modem is the most common method of connecting to the Internet - the computer takes 20 seconds+ to connect to the Internet, and/or makes lots of burbling noises while it tries to connect
Connect to Internet by ISDN (also known as Home Highway, Business Highway, BT Midband - takes 5-10 seconds to connect)
Connect to Internet by satellite (you'll certainly know if you have this - almost certainly a separate dish from any Sky dish you have, and a hefty monthly fee too)
 
NO - Do not currently use the Internet from here

Do not use the Internet - and don't see our doing this in the forseeable future
Do not use the Internet at the moment, but might do in future
   

If you use the Internet now, or might do in future:
Please choose up to THREE benefits of Broadband that would be important to you:
An internet connection that doesn't tie up the normal phone line
A fixed monthly fee for unlimited internet usage
Less time spent waiting for pages of static information to load onto my computer ("downloading")

Faster transfer of large amounts of data from my computers to other computers ("uploading")

(If you could give some idea of what sort of information you'll be wanting to send - eg big documents, audio files, video files), this would be helpful. If you know the sort of size of file, that would be helpful too):

Video phone or videoconferencing
(Don't get TOO excited: a basic BT "Broadband" service will only manage "small-window" videoconferencing. We might be able to offer higher-quality, full-screen, service - but we would probably need to charge a higher monthly fee for those needing this).
Interactive game-playing

Other features - please describe:
   

Any further comments (eg problems with questionnaire, offers of help!)

Thanks for your help.