Language
English (US)
Español
Essential Services Survey
This survey will help us explore your best options to reduce your bills and/or capture a better value.
Are you interested in business and/or individual services?
*
Business
Individual
Which individual services would you be open to hearing about?
Life & Supplemental Health Insurance
Health Care
Mobile Phone Cell Service
Identity Theft Protection
Security & Automation
Gas & Electricity
Internet
Television
Travel
Which business services would you be open to hearing about?
Life & Supplemental Health Insurance
Health Care
Mobile Phone Cell Service
Payment Processing
Security & Automation
Gas & Electricity
Internet
Television
HR & Payroll Solutions
Digital Phone & Cloud Solutions
Back
Next
Save
Individual Essential Services
Please fill out the information below so we can contact you with your results
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Address (No P.O. Box)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Back
Next
Save
Business Essential Services
If you own a business OR help make business decisions for your company, this part of the survey will help us to understand what options would be best for your business.
Are you the business owner or employee for the business?
*
Business Owner
Employee
Other
Contact Person
*
First Name
Last Name
Business Name
*
Type of Business
*
Contact's Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Contact's Email
*
example@example.com
Business Address (No P.O. Box)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Who else will be involved in the decision making process?
*
Back
Next
Save
Life & Supplemental Health Insurance - Individual
Do you have Whole Life Insurance on you and your family?
*
Myself
Spouse
Kids
None of the Above
Not Sure
Do you have coverage for Cancer, Critical Illness, or Accidents? (not including health insurance)
*
Cancer
Critical Illness (Heart Attack, Stroke, Kidney Failure, Organ Transplants)
Accidents
None of the Above
Not Sure
Back
Next
Save
Life & Supplemental Health Insurance - Business
Please note that all insurance options do NOT cost the business anything. These benefits would be voluntary for employees and would save the business on payroll taxes.
Do you have Life Insurance or Supplemental Health Insurance for your employees?
*
Life Insurance
Supplemental Health Insurance
None of the Above
Would you be interested in saving on payroll taxes?
*
Yes
No
Would you be interested in providing more options for life and supplemental health benefits for your employees? (no cost to the business)
*
Yes
No
Back
Next
Save
Health Care - Individual
Do you have Health Insurance?
*
Yes
No
How many members are in your plan?
*
How much is your monthly payment?
*
Are you interested in a free quote?
*
Yes
No
What is the Date of Birth of the oldest member in your household?
*
-
Month
-
Day
Year
Date
Number of Household members?
*
Back
Next
Save
Health Care - Business
Do you have a group insurance policy for your employees?
*
Yes
No
Number of Employees?
No more than 49 employees allowed on one group plan
Are you interested in a free quote for your employees?
*
Yes
No
Back
Next
Save
Payment Processing - Business
Do you currently accept credit cards?
*
Yes
No
How do you accept payments?
Face to Face, in store
Through company website
On the go, mobile
Manuel key entry
How many business locations do you have?
*
Back
Next
Save
Security & Automation - Business
Do you have a doorbell camera or smart business equipment?
*
Yes
No
Is it integrated with your Security system?
Yes
No
I do not have a Security System
If yes, who is your current provider?
eg., ADT, Brinks, VIVINT, etc...
If yes, when does your contract(s) expire?
-
Month
-
Day
Year
Date
If yes, how much is your monthly bill?
Are you open to explore our business security options?
*
Yes
No
What is the best day and time to get a free quote from Vivint? (please make sure time zone is accurate)
Back
Next
Save
Security & Automation - Individual
Do you have a doorbell camera or smart home equipment?
*
Yes
No
Is it integrated with your Security system?
Yes
No
I do not have a Security System
If yes, who is your current provider?
eg., ADT, Brinks, VIVINT, etc...
If yes, when does your contract(s) expire?
-
Month
-
Day
Year
Date
If yes, how much is your monthly bill?
Are you open to explore our security options?
*
Yes
No
What is the best day and time to get a free quote from Vivint? (please make sure time zone is accurate)
Back
Next
Save
Gas & Electricity - Business
(available only in deregulated states)
What state do you live in?
*
Please Select
California
Connecticut
Georgia
Illinois
Indiana
Kentucky
Massachusetts
Michigan
Ohio
Texas
Delaware
Maine
New Hampshire
Pennsylvania
Virginia
Washington D.C.
Maryland
New Jersey
Rhode Island
What plan do you currently have?
Fixed Rate
Variable Rate
I'm not sure
Back
Next
Save
Gas & Electricity - Individual
(available only in deregulated states)
What state do you live in?
*
Please Select
California
Connecticut
Georgia
Illinois
Indiana
Kentucky
Massachusetts
Michigan
Ohio
Texas
Delaware
Maine
New Hampshire
Pennsylvania
Virginia
Washington D.C.
Maryland
New Jersey
Rhode Island
What plan do you currently have?
Fixed Rate
Variable Rate
I'm not sure
Back
Next
Save
Mobile Phone Service - Business
Current Provider
*
How many lines do you have in your plan?
*
How much high-speed data does your plan include?
How much is your monthly plan?
*
EXCLUDE device fees/other charges
Do you owe money on your devices? (installment payments)
*
Yes
No
I'm not sure
How much left do you owe?
Back
Next
Save
Mobile Phone Service - Individual
Current Provider
*
How many lines do you have in your plan?
*
How much high-speed data does your plan include?
How much is your monthly plan?
*
EXCLUDE device fees/other charges
Do you owe money on your devices? (installment payments)
*
Yes
No
I'm not sure
How much left do you owe?
Back
Next
Save
Internet - Business
What type of internet connection do you currently have?
*
Fiber
Cable
No Internet Connection
Current Provider?
Internet Speed?
ex: 300 Mbps, 500 Mbps, 1000 Mbps, etc.
Bundled with:
Television
Phone
Mobile
None
Primary Internet Activity:
Work from Home
Gaming
Streaming
Other
How much is your monthly bill?
When does your contract(s) expire?
-
Month
-
Day
Year
Date
Back
Next
Save
Internet - Individual
What type of internet connection do you currently have?
*
Fiber
Cable
No Internet Connection
Current Provider?
Internet Speed?
ex: 300 Mbps, 500 Mbps, 1000 Mbps, etc.
Bundled with:
Television
Phone
Mobile
None
How much is your monthly bill?
Back
Next
Save
Television - Business
Do you currently pay for TV?
*
Yes
No
Current Provider?
Is your service
Satellite
Streaming
Cable
How much is your monthly bill?
When does your contract(s) expire?
-
Month
-
Day
Year
Date
Back
Next
Save
Television - Individual
Do you currently pay for TV?
*
Yes
No
Current Provider?
Is your service
Satellite
Streaming
Cable
How much is your monthly bill?
When does your contract(s) expire?
-
Month
-
Day
Year
Date
Back
Next
Save
HR & Payroll Solutions - Business
Current Solution in use?
*
Number of Employees?
*
Payroll Frequency
*
Weekly
Bi-Weekly
Semi-Monthly
Monthly
Other
Back
Next
Save
Digital Phone & Cloud Solutions - Business
Take communication to the Next Level.
Do you have business landlines?
*
Yes
No
Are you open to explore our Digital Phone options?
*
Yes
No
Back
Next
Save
Identity Theft Protection - Individual
Have you or your family ever been victims of identity theft?
*
Yes
No
Do you currently have Identity Theft Protection?
*
Yes
No
If yes, who is your current provider?
If yes, how much is your monthly protection?
Do you currently have Anti-Virus / VPN Device Protection?
*
Yes
No
Back
Next
Save
Travel - Individual
Do you currently have a travel savings membership?
*
Yes
No
Current membership?
How much is your membership plan?
Save
Submit
Should be Empty: