Bruce County Broadband Location Survey

Please fill out the form below to help build our case with the province. Important please make sure you include your civic / 911 address so we can plot you on the map.
First Name*
Last Name:*
Company:
Mailing Address:*
2nd Address Field:
City:*
Postal Code:*
Phone*
Fax:
E-mail:
Civic / 911 Address:*
Municipality: *
I need broadband Internet but cannot get it!
I have school aged children that use the Internet
User Type: *
Maximum monthly fee I am willing to pay: *

Privacy Statement: The data submitted in this form will be used only for the purposes of the Rural Connections broadband initiative.