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First Name

Last Name

Daytime Phone Number:

Email address:

Gender:

Age:

When was the last time you participated in a focus group for any company?

Which of the following describe your work status?

What is your ethnicity?

What is your annual household income? That is, the income of you, your partner (if applicable) and others who contribute to home expenses.

In what city do you live?

How many watches do you own?

What brands of watches have you acquired most recently?

How long ago did you acquire the watches mentioned above?

You don't need to fill out any but the top line.

  Within the last 6 months 6 months to 1 year 1+ to 3 years 3+ to 5 years More than 5 years ago
Watch 1
Watch 2
Watch 3
Watch 4
Watch 5

Of the watches you have acquired most recently, could you please note how they were acquired, and if purchased, how much you paid?

You don't need to fill out any but the top line.

  Inherited / Passed on from Family Purchased: Under $1000 Purchased: $1000-2299 Purchased: $2500-4999 Purchased: $5000 or more Other
Watch 1
Watch 2
Watch 3
Watch 4
Watch 5

Could you also please let us know a bit more about your most recently acquired watches?

  Came with Certificate / Document of authentication Still have certificate / Document of authentication Purchased New Purchased New at Discount over 20% Purchased Secondhand (Estate sale, etc.)
Watch 1
Watch 2
Watch 3
Watch 4
Watch 5

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