TO BE ENTERED IN OUR
   DRAWING TO WIN A FREE
   GAS GRILL, PLEASE FILL OUT
   THE BRIEF SURVEY BELOW*:

      First Name:
        
      Last Name:
        
      Address:
        
      City:
        
      State/Province:
        
      Zip/Postal Code:
        
      Phone Number:
        
      Chesapeake Acct #:
        
      Email Address:
        
 
      1. How often do you log onto the Internet?
        
      2. What is your main use of the Internet? (please choose all that apply)
         Shopping  Paying bills  Email  Browsing  Research
      3. Have you used an online bill-paying system?
        Yes No
      4. Would you be interested in paying your Chesapeake gas bill online?
        Yes No
      5. Would you be interested in paying your Chesapeake gas bill by direct debit?
        Yes No
 
 

*(Contest deadline is November 30, 2003. No purchase necessary, one entry per customer,
employees of Chesapeake and/or its subsidiaries are ineligible.)