Consumer Product Registration Survey Template

Consumer product registration, purchase reason, demographics.

Are you:
Did you receive this product as a gift?
How did you first discover this product 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 (products) and wanted more
It is a classic
Good for the whole family
Saw it in the store
I like the (product)
Price/Good value
Primarily, for whom was this product purchased?
Male Female
2 yrs. or younger
3-5 yrs.
6-8 yrs.
9-12 yrs.
13-17 yrs.
18-24 yrs.
25-34 yrs.
35-44 yrs.
45-54 yrs.
55+ yrs.
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.
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.
11 yrs.
12 yrs.
9 yrs.
10 yrs.
What is your annual household income?
Below $20,000

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