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Spencer County Bank

Site Survey Request

If your business or residence is within the Fast-Connect serving area, use this form to submit your request for a Fast-Connect Site Survey: Click Here for maps of the coverage area. A $50 site survey fee will be assessed if your site qualifies for service, but you elect NOT to signup for service within 30 days of the survey. Click Here to see pictures of the installed Fast-Connect equipment.

Computer Qualification:

My computer uses:
My computer has MB RAM
My web browser is
My computer has:   

Phone Number:

E-Mail Address:


Your Name:

Company Name (optional):

Your Street Address:

City:   State:   Zip:

Do you rent   own   your home?

Contact Name (optional):

Contact Phone # (optional):

Comments/Notes: