LW 26-195 In Person Vehicle Evaluation

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.CONTACT INFO Please provide the following:(Required.)

Name

Address

Apt # if applicable

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

3.Please list the Year, Make, and Model for all vehicles currently in your household.(Required.)

1.

2.

3.

4.

4.What is the year, make, model and trim of the vehicle you drive most often?(Required.)

Year

Make

Model

Trim

5.How was the vehicle you drive most often purchased?(Required.)

Purchased New

Leased New

Purchased Used

Leased Used

6.What type of engine does your vehicle have?

Gasoline only

Diesel

Hybrid (gasoline & electric, no plug-in option)

Plug-in Hybrid (gasoline & electric, with plug-in charge option)

Battery Electric only (Fully Electric, no gas. Must plug in to charge)

7.Were you the person most responsible or equally responsible for the decision to purchase this vehicle?(Required.)

Yes

No

8.Are you the principal driver of this vehicle? In other words, is this the vehicle that you drive at least 50% of the time?(Required.)

Yes

No

9.In what type of business are you and any other adult members of your household employed?(Required.)

11.What is/was your specific occupation? Please include job title and industry.

13.What is your exact age?

14.What is your gender?(Required.)

Female

Male

Non-Binary

Other (specify)

16.Do you have any children?(Required.)

Yes, I have kids living at home

Yes, I have kids NOT living at home

No children

17.If you answered YES to the above, please indicate the gender and ages of your children:

19.What is the highest level of education you have completed to date?(Required.)

20.What is your ethnic background?(Required.)

Other (please specify)

21.Are you of Hispanic, Latino, or Spanish Origin?(Required.)

No, not of Hispanic, Latino, or Spanish origin

Yes, of Hispanic, Latino, or Spanish origin

23.Thinking about the next vehicle you will purchase as a replacement for your current vehicle or additional household vehicle, how much do you expect to pay for this new vehicle?

Thank you so much for completing this survey and expressing your interest in this research opportunity. We will review your answers and our recruitment team will contact you if you are a match for the project.
Please note, you must be contacted and confirmed by a recruiter to participate; filling out this survey does not guarantee your participation. Unfortunately, due to the volume of responses we receive, if you do not qualify or if the project is already full, you may not be contacted.

LW 26-195 In Person Vehicle Evaluation - Torrance, CA