Surveys.com: Join Our Community


Last Name:


City / Town:


State:

Phone number:

Mobile phone number:

We often conduct other surveys, for example to try out new products, by mail or telephone. Can we call or mail you if we have this opportunity?

Yes


Birth Date:


Marital status:


Highest level of education completed:


If working, Industry employed in:
	Other:


If working, Type of Employment


Ethnic Origin:


In the last week, on how many separate occasions have you used the Internet, including e-mail, world wide web and other on-line services?


In the last 4 weeks, how many times have you used the World Wide Web from home, work or elsewhere in order to purchase (by which I mean, pay for) products and services?


Household Information
What is your household's combined yearly income?


Do you or does someone else in the household own or rent your home or do you live in it rent free?


Counting yourself and any children, how many people are living in your household?

Verify

To verify you're human please re-type this number in the field below.

Code: