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Customer Demographics
Sample mode - Required questions are not validated
Customer Demographics

The information collected in this survey will only be used for internal customer demogrpahic analysis and will not be sold or distributed to any third party in any way.

Thank you!


Questions prefixed with an * are required
*1. Please enter your gender:
*2. What is your age:
3. Does you household include children under 18 years old:
4.
Age of Child 1
Age of Child 2
Age of Child 3
Age of Child 4
Age of Child 5
Age of Child 6
5. What is your marital status? (optional)
6. What is your current employment status? (optional)
7. What is your highest level of education attainted? (optional)
8. What is you total household income? (optional)
9. Which of these best describes your ethnicity/descent? (optional)
10. What state do you live in?
State

   

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