Skip to content
26-005 Appliances
*
1.
This survey is being conducted by Adler Weiner Research in order to determine your eligibility for a focus group or interview about which you have been contacted. At no point are your individual answers ever sold or shared with our clients (aggregate data or anonymized summaries of the overall survey information may possibly be shared with our clients, however). This survey serves solely as a means for screening. Once the project has been completed this data will be deleted. For more information please see:
Right to Opt-Out Info
Financial Incentive Info
Adler Weiner Privacy Policy
(Required.)
I consent to Adler Weiner Research collecting, storing and processing my personal information for the purpose of determining my eligibility for this market research focus group or interview.
I understand and consent to the following: That should I be eligible for participation in this market research focus group or interview, my contact information (phone, email, and home address) may be shared with the client for purposes related only to this particular project and are not limited to: screening calls to further determine eligibility, sending of "homework" or pre-session assignments via email, allowing access to an online platform via email, or for in-home interviews conducted at your residence.
2.
Please note that these groups will take place in our Irvine, CA facility. Are you able to attend these groups in our Orange County office?
Yes
No
*
3.
CONTACT INFO
Please provide the following:
(Required.)
Name
*
Address
*
Apt # if applicable
City/Town
*
State/Province
*
ZIP/Postal Code
*
Email Address
*
Phone Number
*
4.
Which county do you currently live in?
Orange
Los Angeles
San Bernardino
Ventura
Riverside
Other (please specify)
*
5.
Which gender do you identify with?
(Required.)
Male
Female
Non-Binary/Other
*
6.
What is your age range?
(Required.)
Under 18
18-24
25-34
35-44
45-54
55 +
*
7.
What is your exact age and Date of Birth?
(Required.)
Age:
DOB:
*
8.
Do you or does anyone in your household currently work in any of the following types of companies/industries?
(Required.)
Yes
No
An advertising agency
Yes
No
A marketing company, a market research company, or in a marketing department of a company
Yes
No
A company that manufactures, transports, or sells home appliances or commercial appliances
Yes
No
A company that makes, sells, or promotes cooking utensils and small kitchen appliances
Yes
No
A restaurant, coffee shop, smoothie shop, or a catering business
Yes
No
A company that makes, transports or sells packaged foods or beverages
Yes
No
A company that makes or sells footwear or clothing
Yes
No
Healthcare/Pharmaceuticals
Yes
No
Insurance
Yes
No
Education
Yes
No
Financial services, including banking, investments, financial planning, insurance, etc.
Yes
No
*
9.
Which, if any, of the following types of research projects have you participated in within the past six months?
(Required.)
Online research survey
Telephone research survey
Online research discussion/focus group
Product test (either in-home or at a mall)
In-person focus group
I have not participated in any research in the past 6 months
*
10.
Which, if any, of the following topics was the research about?
(Required.)
Alcoholic beverages
Cleaning supplies/household cleaning
Non-alcoholic beverages
Kitchen appliances, small or large
Food or beverage products
Financial services/credit cards
Pet supplies
Clothing
Vitamins, minerals, and/or supplements
Other (please specify)
None of the above
*
11.
Which of the following best describes your racial background?
(Required.)
Black/Afro Caribbean/African American
East Asian/East Asian American
Filipino/Filipino American
Middle Eastern/North African
Native American/Alaskan Native
Native Hawaiian/Pacific Islander
South Asian/South Asian American
White
Hispanic
Other (please specify)
*
12.
Including yourself, how many people currently live in your household?
(Required.)
1
2
3
4
5+
*
13.
Who else lives at home with you at least part of the time?
(Required.)
Spouse/partner
Roommate(s)
Child(ren) under 18
Child(ren) 18 and over
Parent(s)
Grandparent(s)
Sibling(s) under 18
Sibling(s) 18 and over
Other extended family
Other (please specify)
*
14.
Do you have children under the age of 18?
(Required.)
Yes
No
