Miami Focus Group 2013 Survey

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1. Tell us about yourself

Tell us about yourself First Name:
Last Name
Address:
City/Town:
State:
ZIP (5 digits only):
Email Address: i.e. John@YourProvider.com
Phone Number no dots, dashes or blank spaces please i.e. 9876543210

2. ALTERNATE PHONE NUMBER:No dots, dashes or blank spaces please i.e. 9876543210

ALTERNATE PHONE NUMBER:No dots, dashes or blank spaces please i.e. 9876543210

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3. Gender

Gender

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4. Age

Age 2 digit number only

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5. Month of Birth

Month of Birth

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6. Year of Birth (Note: We never ask for the day)

Year of Birth (Note: We never ask for the day)

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7. Do you have any of the following banking products?

	Credit Cards	Checking Account	Mortgage
1	Do you have any of the following banking products? 1 Credit Cards	Checking Account	Mortgage

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8. Primary Banks Used for Your Accounts

	Credit Card	Checking	Mortgage
1	Primary Banks Used for Your Accounts 1 Credit Card	Checking	Mortgage

Other (please specify)

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9. Highest level of education completed

Highest level of education completed

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10. Marital Status

Marital Status

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11. Ethnicity

Ethnicity

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12. Occupation

Occupation

13. Name of Employer if working

Name of Employer if working

14. Job Title

Job Title

15. Referred by:

Referred by:

Miami Focus Group 2013
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