|
1
|
|
|
|
2
|
Date of purchase:
/
/
(Example: January / 20 / 2002)
|
|
|
3
|
Was this product:
Received as a gift?
Purchased for your own use?
|
|
|
4
|
Which item did you purchase?
DashMat
VelourMat
UltiMat
Custom floor mat
|
|
|
5
|
|
|
|
6
|
Purchase price:
$
.00
|
|
|
7
|
|
|
|
8
|
What type of vehicle will this product be used on?
|
|
|
9
|
How many vehicles are in your household?
|
|
|
10
|
Does this product meet your expectations?
|
|
|
11
|
Your gender:
Male
Female
|
|
|
12
|
Your marital status:
Married
Single
|
|
|
13
|
Date of your birth:
/
/
(Example: January / 20 / 1980)
|
|
|
4
|
Including yourself, how many people live in your household?
Children (18 and younger)
Adults
|
|
|
15
|
Date of birth of children in your household 18 years of age and younger:
|
|
|
16
|
For your primary residence, do you:
Own
Rent
|
|
|
17
|
Education:
(Please select which category applies to you)
|
|
|
18
|
Which best describes your family income?
|
|
|
19
|
I/we buy these things through the mail,
over the Internet, or from television:
|
|
|
20
|
I/we have these credit cards:
|
|
|
21
|
Someone
in my home enjoys:
|
|
|
|
|
Thank you! We appreciate your responses to this questionnaire. The information you choose to share with us will be
used by us and our marketing partners to offer you product information and other communications that may interest
you. If you prefer not to be contacted about these special offers, please check the box at the left.
|
