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	Contact Information:
	Full Name
	Email Address
	Phone Number
	Business Name
	What type of Industry is your business?
	Is your business service or product based?		Please choose.... Service Products
	Is your home business networked?		Yes No
	Do you have a wireless network?		Yes No
	Are you planning on purchasing hardware?		Yes No
	If yes, when?		Please choose... 3-6 months 6 months - 1 year
	Are you planning on purchasing software?		Yes No
	If yes, when?		Please choose... 3-6 months 6 months - 1 year