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Lake Infotech
Survey Form

You are under no obligation to fill out the form in its entirety.
Fill in as much as you are comfortable with.
Fields marked with an asterisk (*) are essential and must be filled in.

By filling in the form, neither you nor we are making any commitments whatsoever. This survey form is for information purposes only.

Full Name*
User ID*
No. of connections*
Age Group*
Address*
City*
Postal Code*
State*
Country*
Phone No.*
Mobile Phone No.
Your E-Mail ID
(Your own E-Mail ID, please, not someone else's.)
Educational Qualification
Education stream/subject
Marital Status Unmarried Married Divorced Widower
Children
under 10 years 		0 1 2 More than 2
Children
above 10 years 		0 1 2 More than 2
Languages you can
speak, read, write 		1. Speak Read Write
2. Speak Read Write
3. Speak Read Write
Your present occupation
(enter all that apply)

Salaried Job
Specify type

Profession
Specify type

Full-time Business
Specify type

Part-time Business
Specify type

Housewife

Unemployed

Student
Specify subject/stream

Your past occupations
(enter all that apply)

Salaried Job
Specify type

Profession
Specify type

Full-time Business
Specify type

Part-time Business
Specify type

Housewife

Your present income per month
Your residence
Your conveyance Public Transport
2-wheeler (make/model)
4-wheeler (make/model)
Which of the following do you/your family own
(enter all that apply) 		Air-conditioner
Cell Phone
Colour Television
Computer
Credit Card
Hot-water Bathroom Geyser
International Passport
Microwave Oven
Refrigerator
Stereo Music System
Have you ever travelled abroad? If yes, please specify some countries
Are you interested in any of the following (enter all that apply) Advertising
Computers/Internet
Conventional Marketing
Indoor Work
Journalism
Movies
Music
Multi-Level Marketing
Outdoor Work
Politics
Books
Sports (Indoor)
Sports (Outdoor)
Stocks/Shares/Investment
Teaching
Team Leadership
Travelling
Please enter your comments on:
Our Internet Service in general
Our Internet Connection Speed
Our Customer Support
Our Complaint Response Time
Our Service Charges/Fees