Table of Contents

 

Personal Contact Information
All personal contact responses will be kept strictly for our confidential use.



1. Your name :
   
   
2. Your mailing address :
   
   
3. Your phone number :
   
   
4. Your email address :
   
   
   

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   Anonymous Demographic Information

   
   

5. Number of pets in household 0 1 2 3 4 5 6 7 8 9 10 15 20
   
   

6. Types of pets in household (check all that apply)
   cat
   dog
   bird
   ferret
   hamster/gerbil
   iguana
   hedgehog
   snake
   sugar glider
   other
   
   
   
7. Your city :
   
   
8. Your state or province :
   
   
9. Your zip/postal code :
   
   
10. Your country : United States Austria Australia Canada Denmark France Germany Hong Kong India Israel Italy Japan Korea, The Republic of Mexico Singapore Spain Sweden Switzerland Taiwan United Kingdom
    

    Enter country if unlisted :
    

11. Your date of birth :(MM/DD/YY)
    
12. Your gender :
    Male
    Female
    
13. Your level of education : Some High School High School Degree Some College College Degree Graduate Degree Professional Degree Other
    
14. Your marital status : Single Married Other
    
15. Number of children : None One 2 - 3 More than three
    
16. Individual employment income level (US$) : Less than $20,000 $20,000 - $29,999 $30,000 - $39,999 $40,000 - $49,999 $50,000 - $74,999 $75,000 - $99,999 $100,000 - $150,000 greater than $150,000
    
    

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    Anonymous Business Information

    
    
17. Employment status : Employed Full-time Employed Part-time (less than 30 hours) Self-employed Student Unemployed Retired Other
    

    If you are employed, please give us the following information:

    
    
18. Company's name :
    
19. Company's ZIP/Postal Code :
    
20. Industry : Agriculture, Forestry, and Fishing Communications - telephone Communications - radio and TV Communications - cable and other pay TV Communications - other Construction Manufacturing - nondurables (e.g. food, clothing) Manufacturing - printing and publishing Manufacturing - electronic/computer equipment Manufacturing - other durables (e.g. autos, machinery) Manufacturing - other Mining Public Services/Government Public Utilities (electric, gas, etc.) Retail Trade Services - prepackaged software Services - computer and data processing Services - other computer related services Services - finance, insurance, real estate Services - media/marketing/advertising Services - law Services - banking Services - other business to business (e.g. consulting) Services - health care - doctor Services - other health care Services - entertainment Services - personal ( laundry, cleaning, etc.) Services - educational Services - other Transportation Wholesale Trade Other
    
21. Professional title/function : Executive Managerial Administrative Clerical Sales Technical Doctor/Lawyer Other
    
22. Your company's size (# of employees) : 1-9 10-99 100-499 500-999 1000+
    
23. Level of purchasing authority (US$) : none below $10,000 $10,000 - $100,000 greater than $100,000

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