Consumer Product Registration Template

Consumer [PRODUCT] registration, demographics and purchase reason.


   
 
Are you:
 
Male
 
Female
 
   
 
Did you receive this [PRODUCT] as a gift?
 
Yes
 
No
 
   
 
How did you first discover this [PRODUCT] that was available for purchase?
 
Advertising - TV, newspaper, magazine, radio
 
Ad in another [PRODUCT] - brochure, preview
 
Friends/Family/Someone told me about it
 
Read a magazine article/review
 
Saw it in the store/Browsing in store
 
Through the mail/mail catalog
 
Other
    
 
   
 
What is the one reason you purchased this [PRODUCT]?
 
Someone asked for it
 
Makes a great gift
 
Own other [PRODUCT]s and wanted more
 
It is a classic
 
Good for the whole family
 
Saw it in the store
 
I like the [PRODUCT]
 
It was on sale
 
Other
    
 
   
Which store did you purchase this [PRODUCT] from?
 
   
 
   
How much did you pay for this [PRODUCT] (US dollars)?
 
   
 
   
 
How many total [COMPANY NAME] [PRODUCT]s do you own?
   
   
 
How many total [PRODUCT]s of any brand do you own?
   
   
 
How many total [COMPANY NAME] [PRODUCT]s have you purchased in the past 12 months?
   
   
 
How many total [PRODUCT]s of any brand have you purchased in the past 12 months?
   
 
   
 
Your age:
 
12 yrs. or younger
 
13-17 yrs.
 
18-24 yrs.
 
25-34 yrs.
 
35-44 yrs.
 
45-54 yrs.
 
55-64 yrs.
 
65+ yrs.
 
   
 
How many children under 17 yrs. or younger live in your household?
   
 
   
What are the ages of the children in your household? (Check all that apply)
Boys Girls
Under 6 mos.
6-11 mos.
1 yr.
2 yrs.
3 yrs.
4 yrs.
5 yrs.
6 yrs.
7 yrs.
8 yrs.
13-17 yrs.
 

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