Shrinkabill Page #3

Thank You for Your Submission!

We'll get started on your account right away!
Maximize your savings potential!
Spend 20 seconds to provide your negotiation preferences below.

This can increase your savings potential by over 60%!

(This is also where you enter your promo codes)
Please identify the bills you've sent us*

Bundle: Internet + TV + Landline/VoIPBundle: Internet + TVBundle: Internet + Landline/VoIPBundle: TV + Landline/VoIPInternet (Non-bundled package)Landline/VoIP (Non-bundled package)TV (Non-bundled package)Cell PhoneGym MembershipHome Security / Home AutomationTrashSatellite RadioOther(s)
Bundle: Internet+ TV + Landline/VoIP
Estimate how long you have been with your internet + TV+ landline/VoIP provider.
Did you negotiate your triple play bundled bill within the last 3 months?
Bundle: Internet + TV
Estimate how long you have been with your internet + TV provider.
Did you negotiate your double play bundled bill within the last 3 months?
Bundle: Internet + Landline/VoIP
Estimate how long you have been with your internet + Landline/VoIP provider.
Did you negotiate your double play bundled bill within the last 3 months?
Internet (Not part of a bundled package)
Estimate how long you have been with your internet provider.
Did you negotiate your internet bill within the last 3 months?
Bundle: TV + Landline/VoIP
Estimate how long you have been with your TV + landline/VoIP provider.
Did you negotiate your double play bill within the last 3 months?
TV (Not part of a bundled package)
Estimate how long you have been with your TV provider.
Did you negotiate your TV bill within the last 3 months?
Landline/ VoIP (Not part of a bundled package)
Estimate how long have you been with your landline/ VoIP provider.
Did you negotiate your Landline/ VoIP bill within the last 3 months?
Cell Phone
Estimate how long you have been with your cell phone provider.
Do you want us to optimize your plan? (Example: you consistently use 4 GB of data, but are on a 10 GB plan, so we move you to a 6GB plan. If we make any changes, we will always leave a slight cushion.)*

YesNo
Did you negotiate your Cell Phone bill within the last 3 months?
Gym Membership
Estimate how long you have been with your gym.
Please list the typical times you go to the gym. (Be sure to specify AM or PM.)
Did you negotiate your gym membership within the last 3 months?
Home Security/ Home Automation
Estimate how long you have been with your home security/ home automation provider?
If you own your home, what insurance company provides your homeowner's insurance?
*Leave this question blank if you do not own your own home.
Did you negotiate your home security/ automation bill within the last 3 months?
Trash
Estimate how long you have been with your trash provider.
Would you be willing to reduce your trash can size?*

Yes- if it saves me money!No
Did you negotiate your trash bill within the last 3 months?
Satellite Radio
Estimate how long you have been with your satellite radio provider.
Did you negotiate your Satellite Radio bill within the last 3 months?
Other Bills
Estimate how long you have been with this "other" provider.
Did you negotiate your "other" category of bills within the last 3 months?
Are you dissatisfied with any of the service providers that you submitted bills for?

YesNo
Have you already escalated the matter(s)?*
Please provide in detail the source of your dissatisfaction.*
EITHER list all providers you're NOT willing to extend your contract with, OR acknowledge you're willing to extend all contracts.*
NOTE: By omitting to mention a provider, you are authorizing us to extend your current contract.
Do you authorize us to automatically renegotiate your bills when the savings period expires?

YesNo
What is your gender?

MaleFemale
Some providers require a verbal pin to speak about an account over the phone. If your service provider requires this additional information, please provide it below.
What is your birth date?

MonthDayYear
What's the last 4 digits of Social Security Number?
Phone Number
Promotional Coupon Code
Valid Promo
Invalid Promo

Thank You for Your Submission!

Maximize your savings potential!Spend 20 seconds to provide your negotiation preferences below.

Bundle: Internet+ TV + Landline/VoIP

Bundle: Internet + TV

Bundle: Internet + Landline/VoIP

Internet (Not part of a bundled package)

Bundle: TV + Landline/VoIP

TV (Not part of a bundled package)

Landline/ VoIP (Not part of a bundled package)

Cell Phone

Gym Membership

Home Security/ Home Automation

Trash

Satellite Radio

Other Bills

Maximize your savings potential!
Spend 20 seconds to provide your negotiation preferences below.