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595 In Home Opinion Study
*
1.
Contact Info
(Required.)
Name
Phone
E-Mail
Gender
Age
City, State
Zip Code
*
2.
Can you confirm that you agree to have no more than MAX ONE person at home at the time of the study?
(Required.)
Yes
No
*
3.
Are you the sole owner/legal tenant of this home?
(Required.)
Yes
No
4.
If no, do you have the permission of the co-owner / partner of your hime to take part in this research study?
Yes
No
*
5.
Do you work for any of the following companies?
(Required.)
A. SAMSUNG
B. APPLE
C. GOOGLE
D. MICROSOFT
E. DELL
F. HP
G. ACER
H. LENOVO
I. SONY
J. AMAZON
K. IBM
L. FACEBOOK
M. HUAWEI
N XIAMOI
O. OPPO
P. ASUS
Q. HTC
R. FOXCONN
S. None of the above
*
6.
Are you a US Citizen?
(Required.)
Yes
No
*
7.
Do you have at least 4 rooms in which we will be allowed to collect data? During which time you would not be able to enter into these rooms. Please confirm this will be possible.
(Required.)
Yes
No
*
8.
Do you live in a
(Required.)
Apartment
Townhouse
Single Family House
Multi Family House
Other (please specify)
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