Application for a BISmark router
Please fill out the following form in order to provide us with the information necessary to consider your application and ship you a BISmark router. We may or may not send routers to any or all who complete this form.

You must read and confirm that you agree with all of the notices contained here: http://projectbismark.net/participant/notices/
Sign in to Google to save your progress. Learn more
Participation Agreement
Check the box below to affirm that you have read, understood, and agree with the BISmark participation agreement (http://projectbismark.net/participant/notices/), including running the BISmark active measurements as part of your participation in the project, and returning the router in the even that you decide not to participate in the project at a later date.
BISmark Participation Agreement *
Required
Contact Information
This information will only be used to contact you when necessary, and will not be shared.
First Name *
Last Name *
Email address *
Telephone *
Shipping Information
This information will only be used to ship you a router and will not be shared. Aggregate-level information (city, state, country) may be used to organize the data we collect from you.
Street Address *
Apt/Unit #
City *
State *
Country *
Zip/Postal Code *
Internet Service Information
This information will be used to plan our deployment and organize the data we collect from you.
Internet Service Provider *
Access technology *
Upstream Throughput (if known)
kbps (kilobits per second)
Downstream Throughput (if known)
kbps (kilobits per second)
Optional Information
Are you interested in participating in behavioral research related to home network use?
We will contact you when we need subjects for research projects.
Notes or special instructions
(if you already have a router, please type in the MAC address [all CAPS, no colons] printed on the bottom of the router here)
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms