Product Registration (General)

Store type, demographics, product attributes, purchaser interests... good general survey.



   
Introduction text here.
 
   
 
Type of store did you purchase [PRODUCT] from?
 
Department Store
 
Shoe Store
 
Clothing Store
 
Sporting Goods Store
 
Army-Navy/Work Store
 
Marina/Boating Store
 
Mail Order Catalog
 
Received as a Gift
 
Internet
 
Other
    
 
   
 
Please check the most important reason why you chose to purchase this particular [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
 
   
 
What one factor most influenced you to purchase [BRAND_PRODUCT]?
 
TV Ad
 
Radio Ad
 
Magazine Ad
 
Newspaper Ad
 
Friend's Recommendation
 
Salesperson's Recommendation
 
In-Store Display
 
Previous Ownership
 
Other
    
 
   
 
What is your age?
   
 
   
 
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.
 
Other
    
 
   
 
For your primary residence, do you:
 
Own a house?
 
Rent a house or apartment?
 
Own a townhouse or condominium?
 
Other
    
 

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