Broadband Service Provider Response Template

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Overview

Instructions
Summary
Service Tiers
Coverage and Subscription Data
Points of Presence

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Sheet 1: Instructions

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Sheet 2: Summary

Summary Comments
	Service Provider Name:
	Point of Contact Name:
	Point of Contact Phone #:
	Point of Conact Email Address:
	(Optional) Summary Comments:

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Sheet 3: Service Tiers

Service Tier and Pricing Table
	Service Provider Name:
	Broadband Service Tier Name	Broadband Platform	Downlink Speed	Uplink Speed	Price Per Month	Geographic Scope	Other Key Features, Terms, or Limitations

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Sheet 4: Coverage and Subscription Data

Coverage and Subscription Data
	Service Provider Name:
	Census Tract or Block Group Number	Number of Households	Number of Households with Access to Broadband from Service Provider	Number of Households Subscribing to Broadband from Service Provider	Highest Available Speed Tier Offered by Service Provider (in Mbps)

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Sheet 5: Points of Presence

Points of Presence
	Service Provider Name:
Facility Name	Address Line 1	City	State	Zip	Longitude	Latitude	Brief Description	Middle Mile Services Available