PROS Home Savings Scanner

Full Name *

Phone *

Email *

Homeowner

Renter

Address

Street Address *

City *

State *

Country

Postal Code *

Services you Currently Pay For

TV Service Check

Do you currently pay for TV Services?

Yes

No

Monthly TV Bill

Under $80

$80-$120

$120+

Would you like us to check of you qualify for lower TV Promotions?

Yes

No

Internet Service Check

Who Provides your home internet?

Monthly Internet Bill

Under $60

$60-$90

$90-$120

$120+

Are you interested in faster internet for less money if available?

Yes

No

Mobile Phone

Who is your current phone provider?

AT&T

T-Mobile

Verizon

Other

How many phone lines do you currently have?

1

2

3

4+

What is your total monthly phone bill?

$0-$100

$100-$200

$200-$300

$300+

Would you like to see if you can lower your phone bill?

Yes

No

Home Security

Do you currently have home security?

Yes

No - I am interested

No - Not interested

What do you currently pay monthly for Home Security?

$0-$40

$40-$80

$80+

Would you like us to check security upgrades or savings?

Yes

No

Energy Savings

Average Electric Bill

Under $100

$100-$200

$200-$300

$300+

Interested to see if you qualify to lower your electric bill through state programs?

Yes

No

Maybe- Need more info

IF YES: Upload Electric Bill (Last 12 months usage)

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF

Follow Up

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