Home Study #3733
Exit Survey
Questions marked with a
*
are required
23%
Contact Information
First Name
Last Name
Address Line 1
Address Line 2
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
District of Columbia
Zipcode
Phone
Email Address
Do you or any of your family or friends work in any of the following industries?
A company that sells, markets, designs, manufactures, or distributes clothing or apparel
Advertising agency or advertising department within an organization
A company that sells, markets, manufactures, distributes, services or installs small or large appliances
A pharmaceutical company
A company that sells, markets, manufactures, distributes, services or installs household devices (such as thermostats, air conditioners, air purifiers, heaters, fans, etc.)
A market research company or the market research department of an organization
A telecommunication firm
An agency offering or selling health insurance policies or consultancy firms
A company that sells, markets, manufacturers, distributes or services home security products
A food, beverage retailer, wholesaler, or distributor
A fast food restaurant or food manufacturing company
None of these
Have you participated in any focus groups or research studies, not including online surveys, in the past 6 months?
Yes
No
Which of the following best describes your residential status?
I personally own my home
Rent
Live with friends or parents
Other
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