## Register your interest for better broadband

### Please enter your details below of the location where you have poor/limited or no broadband availability - you are under no obligation, it simply helps us keep you informed about the project and alert you when fibre broadband reaches you.

- Are you a business or resident? Please Choose  
  Resident  
  Business

- Register for better broadband

- The postcode of the location that you wish to register your interest for better broadband?

- Your name

- Your contact address

- Your email address*

- Email again*

- Your Telephone

- What is this location  
  Select One  
  Home based business  
  Business premises

- How many people do you employ at this location?  
  Select One  
  1-2  
  3-9  
  10-29  
  30-49  
  50-99  
  100-199  
  More than 200

- Do you have broadband at this location?*

- Yes
- No

- If you have no broadband at this location is it because of;  
  Select One  
  No broadband coverage in the area  
  There is broadband but I haven’t signed up for it  
  Other Reasons (please provide brief details)

- No Broadband - Other Reasons

- Do you know what the average speed of your internet connection is (megabits per second)?*

- Would you be prepared to pay more for an improved (higher speed) internet connection?

- Yes
- No

- If Yes, how much more extra would you be prepared to pay (per month) for a faster connection?  
  Select One  
  Under £5  
  £5-£10  
  £11- £20  
  £21-£30  
  £31-£50  
  £51-£75  
  £76-£100  
  More than £100

- We would like to contact you in the near future to let you know about specific business support that we may be able to offer you to help your business grow and develop using superfast broadband (is this OK)?

- Yes
- No

Thank you for registering your interest. This will help us keep you informed about the project (through our regular newsletter) and e-alerts, which let you know that superfast fibre-optic broadband has reached your area.

Leeds City Council will hold your information on behalf of the West Yorkshire Authorities, in accordance with the terms of the Data Protection Act 1998. We will use the information to map demand for better broadband services and will only share anonymised analysis of the responses with partners (West Yorkshire local authorities) and broadband providers. No personal information or contact details will be shared with any 3rd parties. All information supplied by you will not be used for any other purpose, nor shared with any 3rd parties without seeking consent from you first, other than what is stated above. All information supplied by you will be securely destroyed at the end of the project.

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