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2. ReConnect Program Broadband Pre-subscription Form for Farms and Other Businesses
   Jaguar Communications, in partnership with Scott County, Minnesota, and your Township, is applying for funding from the U.S. Department of Agriculture's ReConnect Program. If successful, this funding will allow Jaguar Communications to bring broadband service to your location. If you are interested in receiving broadband service, please submit your responses to the questions below. (Please note: This pre-subscription form is not a binding commitment made by Jaguar Communications.)
4. Would you be a farm or other business customer?*

   1. Farm
   2. Other business
6. What communications services are you currently using? (Select all that apply.)*

   1. Internet
   2. Landline telephone
   3. Cell phone
   4. Video
   5. Other (please specify below)
8. Other:
10. Approximately how much do you pay per month for each of the services that you use?
12. Internet:
13. Landline phone:
15. Cell phone:
16. Video:
18. Other (please specify):
20. What is the broadband speed that you currently are receiving with your Internet service?*
    -- Select One --None< 10 Mbps downstream< 25 Mbps downstream, but at least 10 Mbps downstream< 100 Mbps downstream, but at least 25 Mbps downstream100 Mbps downstream or aboveI don;t know
22. What broadband speed would you need to meet your farm or business needs?*
    -- Select One --< 10 Mbps downstream< 25 Mbps downstream, but at least 10 Mbps downstream< 100 Mbps downstream, but at least 25 Mbps downstream100 Mbps downstream or aboveI don't know
24. Are you interested in receiving broadband service from Jaguar Communications?*

    1. Yes
    2. No
26. How would you like to be informed when service will be available?

    1. E-mail
    2. Telephone call
    3. Mailer
28. Your name
29. Email Address
31. Phone Number
33. Farm or other business name
34. Email Address
36. Address
38. City
39. State
40. Zip Code
42. By checking "I agree," you consent to and authorize the submission of this form.*

    1. I agree
    2. I do not agree
43. Date: *
    Date:

    Date:
Leave This Blank:


45. 1. Receive an email copy of this form.
46. Email address

    This field is not part of the form submission.

47. Submit

* indicates a required field