Panel Selection Survey

Panel Selection Survey - NM 8%2 HOME TESTING INSTITUTE Box...

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Unformatted text preview: NM 8%2 HOME TESTING INSTITUTE Box 9200 Port Washington, New York 11050—0401 HOW DO YOU WISH TO BE ADDRESSED? Mrs Mr. L: ,‘- Miss 5:." Ms CL} Betore you begin, piease look at the iabel to the left. On it you will find a 7 digit number above your name. Piease copy it into the blank Spaces provided in the top of the box to the right. Next. mark the corresponding oval below each number you have written in. Rev. C." Dr. IF YOUR NAME OR ADDRESS IS PRINTED INCORRECTLY. MARK HERE W C} AND PRINT ONLY THOSE SECTIONS THAT NEED TO BE CHANGED. FIRST NAME LAST NAME STREET APT NO. STATE 21!” CODE This is an invitation to join one of the most interesting consumer groups in America — the HT! panel. Our panel is simply a seiect group of consumers who have agreed to participate in marketing research projects. CITY/TOWN Dear Consumer: Home Testing Institute has been in existence for more than 25 years, and is committed to helping companies improve the products and services available in the marketplace. As a member of the HTI panel, i will be asking you to participate in a variety of studies about your usage, purchase and opinions of various products or services. These studies are generaliy done by questionnaires sent in the maii, but some may be done by phone. On occasion, I may also ask you to try a new product, and then teil me what you liked or did not like about that product. I WANT TO ASSURE YOU THAT ALL THE INFORMATEON YOU PROVIDE WILL BE KEPT STRICTLY CONFIDEN- TIAL. YOUR MEMBERSHIP WILL NEVER COST YOU A DIME, NOR WILL I EVER TRY TO SELL YOU ANYTHING, 0R GIVE OUT YOUR NAME. To get started. please carefully read and follow the instructions below. Then. return the completed form, using the enclosed postage paid envelope. It may take you a whiie before you receive your first questionnaire, but once you start, I’m sure you will enjoy being a part of my panel. I am looking forward to you becoming part of the HT! panei, as we work together as a team . companies improve the quality and variety of products and services availabie to consumers. . . helping Cordiaily, MW Janet Half Director, Consumer Pane! Activities This form is very easy to complete. I Please do not use ink. balipoint or felt tip pen. 0 Fill in oval completely with solid dark mark. INCORRECT MARKS W C? Q' (Xi CE) CORRECT MARK . 0 You may erase cleanly any mark you wish to change. 0 Notes shouid not be written on these forms. 3 Fiil in the oval next to appropriate answer for each question. _-:~: MAKE no MARKS BELOW menus NCS Trans-Optic?" EP04-27 137:3 "an" it you (Jane Jones) are the Female Head of Household, born August 1940, and the Male Head of Household is your husband (Bob Jones}. Wm-anvi/rmnw-rm born June 1935, and another household member is your daughter (Susan I I Mth/itrA-rfir’flgflr: " Jones), born September 1965, and she IS employed for pay, you would enter this information as Indicated to the right. 9 both are PLEASE USE PENCIL ONLY WHEN mm! COMPLETING THIS FORM. . of WWW 0‘": same "'0' Friar-:5: 3 St» For all additional momsz magma l or your mm. peease I { mm.) scum b0 sum to file in their 3 I HOUSEHOLDMEMBEB rNPoeMA‘ooN "‘“““'*“""° W a __ 1. MARITAL STATUS . 1 m . Are you: Married 12..-: Widowed D'Voréw/ if," Single Cfi‘ SNOW“ D” ' No Separated 2. Using the example above. please enter information for Female Head of Household in the first column and Male Head of Household in the second column, Leave the first column blank if there is no Female Head. Leave the second column blank If there is no Male Head. Complete the Other Household Member information for members of your household who lrve at home with you at least 9 months per year. (include boarders, live-in-help, etc.) Please be sure to complete an entire column for each person. HEAD OF fiOUSEHOLD FEMALE PLEASE CAREFULLY PRINT FiRST Br LAST NAME - -: .~'-~i'-.0Tfi£ilflQUSEH°L9 MEMBER-9, A 2 o l s s ! First Name: Month month mm 19- Last Name: Write in Month/Year of Birth: MARK ONLY Month/Year of Birth: Mark one ova! for month of birth, ior year of birth. mark only the last two numbers. For example -— It I you were born in 1940. mark (I in the first column and O in the second column under year. If both are present, what is the relationship between the Male and Female Heart of Household Husband/Wile Other Related Not Related Daughter Other Male Relative Other Female Relative Other Male Other Female For all additional members of your household, please ' be sure to fill in their relationship to you: Yes 7 Employed for pay. -——--——-> NO 3. is female head currently expecting a baby?—-—---—-——-* Yes If yes, what month is baby due? No C; C) C} C} C: ‘7" “,5 CL: C3 (3 C} C J F M A M J J A S 0 N D a 8 a D i! U u LI 8 C 0 e 4. Are you. or any member of your household 3 member n b r t V n t g p t V c of any OTHER organization engaged in testing No - products and,’or conducting surveys? Yes : .r m NAME OF ORGANiZATION irate: LE HfiAK? Mm HEAD - HOUSEHOIJ) HOUSEHOLD E'EDUCATtomeCCUPAIlQrfiAlEfiEEAfl &We-.m-ww"—_;...~; lf BOTH Female and Male Heads are present, be sure to fill in both columns. 5. EDUCATION Grade School Please mark one oval to indicate highest education level achieved, some High SChODI Graduated ngh School E Some College Graduated College I l'li'g Post College Graduate In addition to education level above. mark oval rt attended or graduated (com a technical 0r vocatIOnai school, WWW =Z'_'j.‘ 6. .3, WORK FOR PAY ln a typical week. about how many hours do the lemale and/or male Under 30 hours 1 head of your household work for gay? 30_34 hours 2 (MARK ONE OVAL lN EACH Al’PLICABLE COLUMN] 35 hours 0; more 3 None 9 h. CURRENT OCCUPATION NOT CURRENTLY lN WORK FORCE Housewile/househusband Student Retired Unemployed/temporarily laid off Unable to work Member 01 the Armed Forces ' EACH item-er , nous—emu: ' Which of the occupations CURRENTLY IN WORK FORCE to the right BEST describes Barber/Beautician the kind Of Work done. bV Bartender/Cook/Waiter/Waitress "‘9 fem"? and/C” “We , SERVICE Child Care Worker/Housekeeper/Maid head Of Vol" househokl? ' OCCUPATIONS Dental Assistant/Practical Nurse know that all occupanons Firemazt/Guard/F’oiiceman are not listed. so please L Janitor/Porter pack the one that 25 closest rs Baker/Bumher/Seamstress[Tailor Carpenter/E|eCtrician/Painter/Plumber Construction or Road Machine Operator ll household member is _ . Cons!motion/Shipping Worker working more than one to your job. } job, mark the primary I Delivery/Routeman occupation. Driver — Bus/Taxi/Truck BLUE COLLAR OR Factory Machine Operator UNIFORMED OCCUPATIONS Factory/Railroad Worker Farmer (Manager, Owner, Worker) Fisherman/Gardener/ Lumberman (MARK ONLY ONE MaiIroom/Messenger/Postal Worker l l l Foreman Mechanic/Repairman OVAL 1N EACH F Utility Lineman/Serviceman Accountant is? E. E COLUMN) Administrator/Company Ofticer/Manager/Supervisor Architect/Engineer t. ‘7 Artist/Entertaiiter/Writer Banker/Controller/Financial Analyst Bank Teller/Bookkeeper/Cashier Builder/Contractor Buyer/ Purchasing Agent Clerk (all except safes) Computer Programmer/System Analyst Dentist/Doctor/Optometrist/Pharmacist/Psychologist WHITE COLLAR OCCUPATIONS Business, Non‘managerial Professional Computer/CRTjData Entry/Keypunch Operator Economist/Mathematician/Scientist Educator/Lecturer/ Teacher Insurance Adjuster Lawyer/Paralegal Medical Technician/Paramedic/Registered Nurse/Therapist Owner of Business. Company or Store Public Official Receptionist/Secretary/Typist Religious/Social Worker Sales — Insurance/Real Estate/Services Sales — lnclustrial/ Wholesale Sales v- Retail Technician (except Medical) 10. 11. 12. 13. 14. 15. 16. 17. fififififlflfiiI-mfiéfifisfiiflfi_;= 7. a. 57!” ovals for that number usu'ig ONE oval per column. When would be the most convenient time to cat! you at home? “ HOUSEHOLD lNCOME Please indicate your household's TOTAL ANNUAL lNCOME (for the most recent caiendar year ending in December), Combine the income of all household members, including income from sataries 0r wages. interest. and all other sources. Under S 5.000 C: $ 5000—5» 7,999 $ 8000—55 9.999 r $10,000m$11.999 08 HOME PHONE NUMBER W“) From time to time it may be necessary to telephone you in order to get your opinion quickly. therefore your home telephone number is very Important. Please write in your home ohone number (inciudrng area code) in the space provtdecl. Also, completely mark the appropriate Morning Afternoon $12.000m$14,999 C: 10 S15.000—$19,999 $20.000-$24.999 $25.000»$29.999 1,; 15 11 t3 WOULD YOU PLEASE lNDiCATE YOUR FAMILY BACKGROUND. Are you: White Q; Are you or any members of your householchbif. " of Spanish/Hispanic origin or descent? RESIDENCE Black 2."- Wiiich statement below describes the type oi resrdenco in which you live? One famin house A building for two families ‘ Do you own or rent this residence? WM Own Rent/Lease If this residence rs a Condominium or Cooperative, mark here How long have you lived at this residence? Less than sax months {I}: Six months to one year ‘,., One to two years PET OWNERSHIP Do you own a dog or puppy? -—-—-—> Do you own a cat or kitten? WW———> CASSETTES How many prerecorded video cassettes does your household rent in an average mommm J. [2] 7.31- 143 " " " How many blank video cassettes does your household purchase in an average month? w-—«-—-—————> No :.'_';. No if.“ Have you or anyone in your household bought any records 0r pro-recorded audio tapes/cassettes in the past 12 months? W Yes (I; Which of the tollowing do you have? (MARK ALL THAT APPLY) Microwave oven (countertop. buiit—in. or part of stove) Automatic Dishwasher Garbage Disposal Clothes Washer Clothes Dryer Sewing Machine Private Lawn Garden Swimming Pool Does anyone in your household smoke cigarettes? ABOUT GROCERY SHOPPlNG Who in your household usually does most of the grocery shopping? : Does anyone in your househotd wear; {MARK ALL THAT APPLY] M Contact Lenses Television Comoact Disc Player Video Recorder (VCR) Video Game System {primarily for TV games) Home Computer Cable TV TV Sateliite Dish Cellular Phone (car) Portable Phone Yes C No C)- Female Head does most (:3 Male Head does most C3 Oriental {:3 Yes L3H if yes. how many? Yes (IE-m} if yes, how many? Eyeglasses CL" 1 I‘ll!“ ' Evening " " Anytime $30.000—$34.999 5:» $35.000—E39899 $40,000—$44.999 345,000-“9549399 C? 19 Other LL: A building for three or more families A mobile home or trailer Other WWW-«hr :' , Two to five years More than five years No if; -__.‘)—~> If yes, is it . . . VHS {1:} or :11“; if yes. do you own a modem? C_3——> IF YES, 00 YOU RECEIVE: Onty regular teteviseo programs {3 Regular televised programs plus those if) shown only on pay cable (Cinemax HBO, Bravo. etc.) Both equatly C} Other household member Cr Dentures {I} If yes, how many? it; Q23: (4} s" :; $50,000—$59.999 (:1 21 $50,000—$69_999 $70,000~$99.999 L“: 25 $100000 or over Beta £17; Hearing Aids C3 .~ 27 ...
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Panel Selection Survey - NM 8%2 HOME TESTING INSTITUTE Box...

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