Consumer Product Registration Survey Template

Consumer [PRODUCT] registration, demographics and purchase reason.

Are you:
Did you receive this [PRODUCT] as a gift?
How did you first discover this [PRODUCT] that was available for purchase?
Advertising - TV, newspaper, magazine, radio
Ad in another [PRODUCT] - brochure, preview
Friends/Family/Someone told me about it
Read a magazine article/review
Saw it in the store/Browsing in store
Through the mail/mail catalog
What is the one reason you purchased this [PRODUCT]?
Someone asked for it
Makes a great gift
Own other [PRODUCT]s and wanted more
It is a classic
Good for the whole family
Saw it in the store
I like the [PRODUCT]
It was on sale
How many total [COMPANY NAME] [PRODUCT]s do you own?
How many total [PRODUCT]s of any brand do you own?
How many total [COMPANY NAME] [PRODUCT]s have you purchased in the past 12 months?
How many total [PRODUCT]s of any brand have you purchased in the past 12 months?
Your age:
12 yrs. or younger
13-17 yrs.
18-24 yrs.
25-34 yrs.
35-44 yrs.
45-54 yrs.
55-64 yrs.
65+ yrs.
How many children under 17 yrs. or younger live in your household?
What are the ages of the children in your household? (Check all that apply)
Boys Girls
Under 6 mos.
6-11 mos.
1 yr.
2 yrs.
3 yrs.
4 yrs.
5 yrs.
6 yrs.
7 yrs.
8 yrs.
13-17 yrs.

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