Start Making Money Today by filling out online survey forms!

SAMPLE SURVEY FORM * denotes required field THE BASICS 1. What is your name?* First: Last: Phone #: 2. Your primary e-mail address:* (Please enter carefully) 3. The city/town you live in is… 4. The state you live in is… Select Alabama Alaska Alberta American Samoa Arizona Arkansas British Columbia California Colorado Connecticut Delaware District Of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northern Mariana Is Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Palau Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon Territory 5. Your gender:* Male Female 6. What is your age?* Age 17 or less (We are sorry, you do not qualify.) 18 to 21 22 to 25 26 to 34 35 to 44 45 to 54 55 to 65 66 or older JUST ABOUT KIDS 7. How many children live in your household with you, age 17 or less? 1 2 3 4 5 or more None / No children (PLEASE SKIP TO QUESTION # 13) 8. How many children do you have in each of the following age categories: One year old or less 1    2    3    4 or more Age 2 to 4 1    2    3    4 or more 5 to 7 1    2    3    4 or more 8 to 12 1    2    3    4 or more 13 to 17 1    2    3    4 or more 18 to 21 1    2    3    4 or more Questions #9 through #12 are for female parents of children age 2 - 7 only. Otherwise please skip to question #13. To what degree do you agree or disagree with the following statements: 9. When shopping for my child, I shop at different stores for sleepwear and playwear. Strongly Disagree Somewhat Disagree Neither Agree nor Disagree Somewhat Agree Strongly Agree 10. When shopping for my child, one of the most important things is that the clothes have cute designs. Strongly Disagree Somewhat Disagree Neither Agree nor Disagree Somewhat Agree Strongly Agree 11. When shopping for my child, I prefer to go to stores that specialize in children’s clothing. Strongly Disagree Somewhat Disagree Neither Agree nor Disagree Somewhat Agree Strongly Agree 12. When shopping for my child, I prefer to go to a store that has a wide variety of brands in children’s clothes. Strongly Disagree Somewhat Disagree Neither Agree nor Disagree Somewhat Agree Strongly Agree ACTIVITIES AND SHOPPING 13. Which of the following products have you used in the past week? (PLEASE CHECK ALL THAT APPLY.) Soda or other carbonated drinks Sliced deli meats Salted snacks (such as potato chips or salted nuts) Tobacco cigarettes Bottled water 14. Which of the following activities do you, yourself, actively engage in? (PLEASE CHECK ALL THAT APPLY.) Regular exercise Computer/video games Go to live theatre/plays Attend sporting events Visit art galleries/museums Personal investing other than employment 401Ks Visit night clubs/bars Play board games with friends/family Frequently travel out of state for pleasure Go to the library Do-it-yourself home improvement re-decorating (painting, refinishing) Do-it-yourself home improvement re-modeling (installing new floors, cabinets) Gardening Boating Hunting 15. When it comes to making decisions about products and services for the household costing $500 or more, would you say you are most likely to have… the most influence equal influence with one or more a little influence no influence A FEW LAST QUESTIONS 16. Which of the following best describes your occupation? Executive/managerial Salesperson/buyer Professional/technical Clerical/administrative Warehouse/trade/construction Homemaker Student Not currently employed Retired Other 17. What was the last grade of school you completed? Less than HS graduate HS graduate Some college College graduate or more 18. Which of the following best describes your ethnic background? Caucasian African-American Hispanic or Latino Asian Native American Other SUBMIT FORM (*Above form is example form and is not a functioning form) Start Making Money Today with Online Survey Forms! By simply filling out a survey like the above example, you too can start making money today!  It's a great way to supplement your income in a quick, fast, and easy way.  Make money today in the comfort of your own home by completing online survey forms!

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