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
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
Which of the following describes your purchase of [PRODUCT]?
First time buyer
Repeat purchaser
What one factor most influenced you to purchase [BRAND_PRODUCT]?
Radio Ad
Magazine Ad
Newspaper Ad
Friend's Recommendation
Salesperson's Recommendation
In-Store Display
Previous Ownership
What is your age?
Marital Status:
Single/Never Married
Do you have any children living at home in any of the following age groups?
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
$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.
For your primary residence, do you:
Own a house?
Rent a house or apartment?
Own a townhouse or condominium?

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