Product Registration: Consumer Product

Consumer product registration, purchase reason, demographics.



   
 
Are you:
 
Male
 
Female
 
   
Name of this product:
 
   
 
   
 
Did you receive this product as a gift?
 
Yes
 
No
 
   
 
How did you first discover this product 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 (products) and wanted more
 
It is a classic
 
Good for the whole family
 
Saw it in the store
 
I like the (product)
 
Price/Good value
 
Other
    
 
   
What was the name of the store where this (product) was bought?
 
   
 
   
What price did you pay for this (product)?
 
   
 
   
Primarily, for whom was this product purchased?
Male Female
2 yrs. or younger
3-5 yrs.
6-8 yrs.
9-12 yrs.
13-17 yrs.
18-24 yrs.
25-34 yrs.
35-44 yrs.
45-54 yrs.
55+ yrs.
 
   
How many total (Company Name) products do you own?
 
   
 
   
How many total products of any type do you own?
 
   
 
   
How many total (Company Name) products have you bought in the past 12 months?
 
   
 
   
How many total products of any type have you bought 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 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.
11 yrs.
12 yrs.
9 yrs.
10 yrs.
 
   
 
What is your annual household income?
 
Below $20,000
 
$20,000-$29,999
 
$30,000-$39,999
 
$40,000-$49,999
 
$50,000-$74,999
 
$75,000-$99,999
 
$100,000-$149,999
 
$150,000+
 
   
Name:
 
   
 
   
Address:
 
   
 
   
City:
 
   
 
   
State:
 
   
 
   
ZIP:
 
   
 
   
Phone:
 
   
 

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