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Survey Name Warranty Card Consumer Product
Description Consumer product warranty card: customer identification, usage occasion, demographics.
Category Marketing   (Browse All Categories)

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It would be most helpful if you would fill out the following information.
 
   
Mr.
Mrs.
Ms.
Miss
 
   
First Name
 
 
   
Last Name
 
 
   
Street Address
 
 
   
City, State and Zip
 
 
   
Date of Purchase
 
 
   
Model No. (See Box)
 
 
   
Type of store where purchased:
Department Store
Shoe Store
Clothing Store
Sporting Goods Store
Army-Navy/Work Store
Marina/Boating Store
Mail Order Catalog
Received as a Gift
Internet
 
   
Product Price Paid (excluding tax)
 
 
   
Please check the most important reason why you chose this product. (Check only one.)
Attribute 1
Attribute 2
Attribute 3
Attribute 4
Attribute 5
Attribute 6
Attribute 7
Attribute 8
Attribute 9
Other
 
   
Which of the following describes your purchase of (Product)?
First Time Buyer
Repeat Purchaser
 
   
Please check the primary occasion when you intend to use your new (Product/Brand). (Check only one.)
Usage Occasion 1
Usage Occasion 2
Usage Occasion 3
Usage Occasion 4
Usage Occasion 5
Usage Occasion 6
Usage Occasion 7
Usage Occasion 8
 
   
What one factor most influenced your purchase of the (Brand)?
TV Ad
Radio Ad
Magazine Ad
Newspaper Ad
Friend's Recommendation
Salesperson's Recommendation
In-Store Display
Previous Ownership
Other
 
   
Date of birth of person whose name appears above: (Month and Year)
 
 
   
Marital Status:
Married
Divorced/Separated
Widowed
Single/Never Married
 
   
Do you have any children living at home in any of the following age groups?
None
Baby under 6 months
Baby 6 to 12 months
Age 1
Age 2-4
Age 5-7
Age 8-10
Age 11-12
Age 13-15
Age 16-18
 
   
Which group describes your annual family income:
Under $25,000
$25,000-$39,999
$40,000-$54,999
$55,000-$69,999
$70,000-$84,999
$85,000-$99,999
$100,000-$114,999
$115,000-$129,999
$130,000-$149,999
$150,000 & over
 
   
Which types of credit cards do you use regularly?
American Express, Diners Club, Carte Blanche
Bank card (MasterCard, Visa)
Gas, dept. store, etc.
None of the above
 
   
For your primary residence, do you:
Own a house?
Rent a house or apartment?
Own a townhouse or condominium?
 


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