Count Me In!!!

Your opinion counts!! By completing this form, you will be entering yourself in one of the Internet's premiere panel databases for market research. As a panelist, you will represent consumer's needs and opinions to companies nationwide. Your participation and feedback will shape the way many companies alter their existing products and services and develop new ideas to better serve your needs. Panel members are invited to voice new insights and perspectives on a wide range of topics. Manufacturers will look toward you for feedback on product performance, styling, features, slogans and pricing - just to name a few. In addition, our panelists find the answering surveys fun and interesting - and you can earn money. All surveys have some sort of honorarium attached (and all are clearly spelled out in any invitations you receive from Esearch.com). In some instances there is a raffle (and we try and keep the odds of winning at least 1:40) and in some instances, everyone is paid.

If you have any problems with this questionnaire or questions regarding our purpose, please email us at esearch@esearch.com . We will be happy to answer any questions you may have.

By submitting this completed form, you will be entered into the Esearch.com panel database. This demographic profile will be used to select participants in forthcoming surveys via the Internet.

Please fill in or click on the appropriate answers. When done, click on the Submit button at the end of the survey.

Let us begin with your name:

Please enter your email address (do not send us your postal address):

There are 16 questions that follow.

1. Which of the following best describes your age?

Less than 20
20 to 24
25 to 34
35 to 44
45 to 54
55 to 64
65 or older
Refused


2. Are you married?

Yes No Refuse to answer

3. What is your approximate total annual household income before taxes (US $)?

Less than $30,000
$30,000 to 44,999
$45,000 to $59,999
$60,000 to $79,999
$80,000 to $99,999
$100,000 to $124,999
$125,000 or more
Refused

4. How many household members contribute to this income?

One
Two
Three
Four
Five or more
Refused

5. What was the last year of school you completed?

Some high school or less
High school graduate
Some college/associate degree
Vo-tech graduate
College graduate
Some post graduate work
Post graduate degree
Refuse to answer

6. Including yourself, what is the total number of members living in your household?

1 2 3 4 5 6 7 or more Refuse

7. Are there any children under 18 years living in your household?

Yes No Refuse to answer

8. Which of the following best describes your current employment?

Proprietor/Business owner
Business executive/administrator/director
Middle manager
Professional (doctor/lawyer/CPA)
Skilled technician (engineer/computer programmer)
Police/Postal/Armed Service
Skilled professional (Nurse/Paralegal)
Factory Worker/Truck Driver/Equipment Operator
Educator, Research, Journalist
Salesperson
Farmer, Rancher, Fisherman
Office/Administrative Work
Skilled trade (plumber, electrician, etc.)
Entertainer, artist
Homemaker
Not employed
Student
Retired
Other
Refused

9. (If employed) which of the following best describes the company size?

1 - 4 employees
5 to 9 employees
10 to 19 employees
20 to 49 employees
50 to 99 employees
100 to 249 employees
250 to 499 employees
500 to 999 employees
1000 or more employees
Unknown

10. (If employed) which of the following best describes the industry your company is involved in?

Agriculture, forestry or fishing
Mining
Construction
Manufacturing
Transportation, communications or utilities
Wholesale trade
Retail trade
Finance, insurance or real estate
Services
Public administration

11. Gender

Male Female

12. Name three activities or hobbies you most like to pursue in your leisure?

13. What Internet capabilities do you have?

Email
WWW
Gopher, Archie, etc.
FTP, TELNET
UseNet
IRC
Other

14. Is your Internet account set up for use on:

Home computer
Business computer
Both home and business computer
School computer
Other

15. What country do you live in (please spell out)?

16. What is your ZIP or Postal Code?




Please click the Submit Button to add your completed profile to our database and to enter our periodic drawing. You will not be in our database or entered into the contest until you complete the survey and successfully transmit the results to us. Once you click the submit button, you should get a "Thank you" screen indicating that your profile was successfully transmitted. If you do not get the "Thank you" screen, try clicking the submit button again.

If you have problems, email us at esearch@esearch.com .

If you would like to start over, click the Reset Button and all your answers will be erased.