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I purchased this model in:
   
 
I purchased this model at the following store:
 
Radio/TV
 
General Merchandise
 
Catalog
 
Appliance
 
Discount
 
Car dealer
 
Other
 
   
 
I learned about this model from:
 
Newspapers
 
Newspaper supplement
 
Magazines
 
Direct Mail
 
Television
 
Radio
 
Catalog
 
A friend
 
Retailer
 
Store display
 
Other
 
   
 
I decided to buy this model:
 
Before coming to the store
 
In the store
   

I decided to buy this model because of:
 
Sound quality
 
Ease of operation
 
Ease of installation
 
[COMPANY] Brand
 
Styling/Appearance
 
Recommendations of friends
 
Recommendations of dealer
 
Previous experience with [COMPANY]
 
Price
 
Other
 

   
 
I like the following features:
 
Feature 1
 
Feature 2
 
Feature 3
 
Feature 4
 
Feature 5
 
Feature 6
 
Other
 
   
 
I purchased this model:
 
As first set
 
As replacement set
 
As additional set
 
Other
 
   
 
If this purchase was not your first set, the previous one was used for:
 
1 year
 
2 years
 
3 years
 
4 years
 
5 years
 
Other
 
   
 
Before I purchased this, I compared it with:
 
Brand 1
 
Brand 2
 
Brand 3
 
Brand 4
 
Brand 5
 
Brand 6
   
 
My family income is:
 
under $25,000
 
$25,000 - $40,000
 
$40,000 - $60,000
 
$60,000 - $80,000
 
$80,000 - $100,000
 
$100,000 and over
   
 
Sex
 
Male
 
Female
   
 
Marital Status
 
Married
 
Single
 
Other
   
 
Age
   
 
Occupation
   
 
Name:
   
Address
   
 
   
City
   
State, ZipCode
   
Email Address
   


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