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60 Seconds in Completing This Survey Could Get You a

$10 Check or a Domino's Pizza Gift Card!

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Thank you for participating in this brief survey. The information gathered from your answers is for research purposes based on your location, age group, and other factors.

Personal information gathered will not be sold to any other firm or organization. For our overall results to be valid, and to be eligible for your complimentary gift card, all questions must be completed.

Once we receive your answers and have confirmed you are employed, you may expect to receive your complimentary reward in two to four weeks.

If you received our postcard by mail asking you to complete a brief 60 second survey and you are currently employed, we will happily reward you with a $10 check or a single-topping pizza gift card.

Take the brief survey below and receive your reward.
It's that simple!

To qualify, you must:

1) Be employed
2) Fill out the below survey completely
3) The survey MUST be filled out by the person to whom it was addressed. This offer is not transferable. We carefully select recipients based on a specific criteria.

We do NOT sell mailing lists. You will NOT be identified in our survey reports. Again, ALL items must be filled out in order to qualify for the $10 check or pizza gift card.

Pizza gift cards available while supplies last. A $10 check may be substituted as our thanks.

Survey

You must fill out all of the information below in order to receive your check for $10 or a Domino's pizza gift card. This offer is only valid if you have received our request by mail to participate in this survey and is not transferrable.

Offer Number: (This is the number appearing above your name on the front of the postcard; IF you have one. If not, leave blank)
First Name:
Last Name:
Address:
City:
Zip Code:
State:
Employer's Name:
Employer Address:
Employer City, State:
Employer Phone:
Your Education:
Persons in Household in Age Group: (check all that apply)	12 and under
	13-19
	20-29
	30-39
	40-49
	50-59
	60+
How Would You Describe Yourself as a Shopper: (hold down ctrl button if you select more than one choice)
How many miles from home do you shop for groceries
For banking, I use a:
How many miles from home do you bank:
I would recommend the following bank to a friend:
Select Your Reward for Responding to This Survey:
Email: