Skip to content
In-Home Project
*
1.
Please provide your shopper ID (I.e., SShop001) or email
(Required.)
2.
Please provide your address.
3.
Please provide your phone number.
*
4.
In what type of home do you reside?
(Required.)
Single-Family Home
Townhome
Apartment
Other (please specify)
*
5.
Please select which of the following rooms are available for scanning in your home:
(Required.)
Living Room
Adult/Teen Bedroom
Dedicated Home Office
Kitchen
Dining Room
Game Room
Child's Bedroom
Bathroom
Garage
Other (please specify)
*
6.
Please select your current household annual income range:
(Required.)
Less than $43,350 a year
Between $43,351 and $130,000 a year
Greater than $130,000 a year
*
7.
What is your primary ethnicity?
(Required.)
White or Caucasian
Black or African American
Hispanic or Latin American
South Asian
Southeast Asian
East Asian
West Asian/Middle Eastern
Other (please specify)
*
8.
Please select days of the week you can be available for this project:
(Required.)
Monday
Tuesday
Wednesday
Thursday
Friday
Not Available During the Week
*
9.
Please select times of day you can be available for this project:
(Required.)
Dawn
Daytime
Dusk
Night (After Dark)
*
10.
This project requires an adult age 18 or over be present for the duration of the mapping visit. Do you confirm that you will be present during the entire 4 to 5 hour scheduled appointment?
(Required.)
Yes
No
*
11.
This project requires that you remove or cover any photos or other personal identifying information in your home prior to the scheduled appointment. Are you able and willing to do this prior to the appointment?
(Required.)
Yes
No
12.
Do you know of any business owners with corporate offices who may be interested in this project? If so, please enter a name and contact information for each referral. For each company that agrees to, and successfully completes, this study, you will be compensated $50.
Name of Business Owner
Name of Business
City and State of Business
Email of Business Owner
Phone of Business Owner