Home Services Survey
Thank you for taking the time to complete this survey to assist us in finding the best offers for you. Once submitted, Amira will be in touch with you soon.
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Phone Number
*
Please enter a valid phone number.
E-mail
*
example@example.com
Do you currently receive your bills electronically?
Yes
No
No but I would like to
Mobile Services
Current Provider
How many mobile services in your household?
Monthly bill is approx $
Is your service prepaid or on a plan? (choose one)
Prepaid
Plan
Not sure
Do you need a new handset?
Yes
No
Not sure
What type of contract term interests you?
Month to month
12 month contract
24 month contract
Prepaid
Not sure
What is your preferred mobile handset?
Android
Apple
Other
No preference
Do you have a preferred network?
Telstra
Optus
Vodafone
No preference, just want the best deal
What is the data inclusion on your current mobile plan?
Is the data inclusion enough?
Yes
No
I'm not sure
Do you call internationally/would be interested in international call inclusions?
Yes
No
Not sure
Broadband Internet
Current provider
Monthly bill is approx $
Is your address nbn™ ready?
Yes
No
I'm not sure
Monthly data usage is approx?
Type of service you currently have?
ADSL
Naked DSL
Mobile Broadband
Nbn
Cable
I'm not sure
Wireless
Mobile Broadband
Current provider
Monthly bill is approx $
What is the data inclusion on your current mobile plan?
What is the end date of your contract? (if applicable)
Type of mobile broadband I am interested in:
Mobile wifi
Tablet/ipad
SIM only
Do you currently have a tablet/iPad?
Yes
No
If yes, does your tablet/iPad take a SIM card?
Yes
No
If no, would you be interested in taking up a new tablet/iPad on a plan?
Yes
No
Energy
Current Services?
Electricity
Gas
Solar
Current provider/s
How much is your current quarterly electricity bill? (if monthly please specify)
How much is your current quarterly gas bill?
Are you currently receiving any discounts?
Yes
No
I'm not sure
If yes, what is your electricity discount?
If yes, what is your gas discount?
If yes, what is your electricity discount?
Home Insurance
Current Policy
Landlord
Contents
Home
None
Current Insurer/s
How long have you been with your current insurer?
Travel Club
Do you currently have a Travel Club membership?
Yes, Answer questions just below
No, Please see further down
Who is your current membership with?
Monthly membership fee is approximately $
Are you locked into a contract?
Yes
No
Not sure
If yes, what date does your membership expire?
Would you be interested in learning more about the benefits of a new travel club?
Yes
No
Not sure
Do you currently have a Travel Club membership?
No, Answer questions below
How often do you usually travel either within Australia or Overseas?
Every month
Every 2 months
Twice per year
Once per year
Never
Tick any of the below boxes which you are interested in:
Holidays in Australia
Holidays overseas
Deals on flights
Deals on accommodation
Hotel credits
Access to a personal travel agent
Booking entertainment and experiences
Access to VIP airport lounges
Flight accident insurance
Medical assistance while overseas
Other
Would you be interested in learning about the benefits of travel club membership?
Yes
No
Not sure
Do you have any questions for us?
Submit Feedback
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