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Questions marked with an * are required Exit Survey
 
 
What is your gender?
 
Male
 
Female
 
 
 
What is your age?
 
Younger than 18
 
18 - 24
 
25 - 34
 
35 - 44
 
45 - 54
 
55 - 64
 
65 or older
 
Prefer not to answer
 
 
 
What is your Marital Status?
 
Single
 
Married
 
Engaged
 
Widowed
 
Divorced
 
 
 
Are You Currently Employeed?
 
YES
 
NO
 
 
 
Which category best describes your annual income?
 
Under $15,000
 
$15,000 - $29,999
 
$30,000 - $44,999
 
$45,000 - $59,999
 
$60,000 - $74,999
 
$75,000 - $89,999
 
$90,000 - $104,999
 
$105,000 - $119,999
 
$120,000 or more
 
Prefer not to answer
 
 
 
What is your current home status?
 
Owned
 
Rented/Leased
 
Other
 
 
 
 
How many people live in your home?
 
1
 
2
 
3
 
4
 
5+
 
 
 
 
Do your currently own or rent a Water Softener or RO System?
 
YES
 
NO
 
 
 
What Brand or Water Softener & RO Do you Currently Have
   
 
 
 
* First Name : 
* Last Name : 
* Address 1 : 
   Address 2 : 
* City : 
* State : 
* Zip : 
* Phone : 
* Email Address : 
 
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