Beverages

Hello and thank you for being a part of the Q-insights database.

We are conducting an online blog study that will take place June 5th, 6th, 7th & 9th and we are interested in your opinions. If selected, you would be asked to complete 4 days of activities, which would involve answering questions online and uploading photos and videos on the blogging platform. Upon successful completion you will be compensated $150.

If you are interested in participating, please complete the questionnaire below. If you pre-qualify a recruiter will be in touch with you to ask a few additional qualifying questions.

Thank you

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* 1. What is you gender?

Male

Female

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* 2. What is your age?

100

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 3. What is your employment status?

Employed full time

Employed part time

Student

Retired

Unemployed

Housewife

Other (please specify)

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* 4. Can you please indicate in which city have you been living during the past 5 years?

New York

Los Angeles

Other (please specify)

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* 5. Please select your current living situation

Married/Living with Partner

Married and living with child(ren)

Single (Never Married)

Singe (Divorced/Separated/Widowed)

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* 6. Which best describes your ethnic background?

African American

Caucasian

Hispanic

Asian

Other

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* 7. Which of the following products have you bought in the past 3 months, more than 3 months ago, or you never bought/would never buy

	Bought in the past 3 months	Bought more than 3 months ago	Have never bought/would never buy
Premium bottle water	Premium bottle water Bought in the past 3 months	Premium bottle water Bought more than 3 months ago	Premium bottle water Have never bought/would never buy
Plain still flavored bottle drinks	Plain still flavored bottle drinks Bought in the past 3 months	Plain still flavored bottle drinks Bought more than 3 months ago	Plain still flavored bottle drinks Have never bought/would never buy
Juice or Juice drinks	Juice or Juice drinks Bought in the past 3 months	Juice or Juice drinks Bought more than 3 months ago	Juice or Juice drinks Have never bought/would never buy
Soft drinks with fruit juice	Soft drinks with fruit juice Bought in the past 3 months	Soft drinks with fruit juice Bought more than 3 months ago	Soft drinks with fruit juice Have never bought/would never buy
Flavored non carbonated ("still") bottle water	Flavored non carbonated ("still") bottle water Bought in the past 3 months	Flavored non carbonated ("still") bottle water Bought more than 3 months ago	Flavored non carbonated ("still") bottle water Have never bought/would never buy
Ready to drink iced tea	Ready to drink iced tea Bought in the past 3 months	Ready to drink iced tea Bought more than 3 months ago	Ready to drink iced tea Have never bought/would never buy
Coconut no dairy beverages	Coconut no dairy beverages Bought in the past 3 months	Coconut no dairy beverages Bought more than 3 months ago	Coconut no dairy beverages Have never bought/would never buy
Aloe vera beverages	Aloe vera beverages Bought in the past 3 months	Aloe vera beverages Bought more than 3 months ago	Aloe vera beverages Have never bought/would never buy
Infusion drinks	Infusion drinks Bought in the past 3 months	Infusion drinks Bought more than 3 months ago	Infusion drinks Have never bought/would never buy
No sparkling energy drinks	No sparkling energy drinks Bought in the past 3 months	No sparkling energy drinks Bought more than 3 months ago	No sparkling energy drinks Have never bought/would never buy

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* 8. Which of the following brands are you aware of?

Hint Water

VitaminWater

Arizona

Lipton

Nestea

Capri Sun

Nestlé Pure Life Splash

Private Labels

Acqua Panna

Voss

Smartwater

Life WTR

Evian

Fiji

Essentia

Icelandic

Aqua Hydrate

Waiakea

Core

Other Flavored (please specify)

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* 9. Which of the following type of device do you have and regularly use?

Smartphone with Internet Wi-FI/3G connection

Laptop/PC internet connection

Tablet with internet Wi-Fi/3G connection

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* 10. please indicate me which of the following activities do you do when surfing on internet?

	Everyday	At Least 4 times a week	1-2 times a week	Rarely	Never
Social network: Facebook – to keep in touch with family and/or friends	Social network: Facebook – to keep in touch with family and/or friends Everyday	Social network: Facebook – to keep in touch with family and/or friends At Least 4 times a week	Social network: Facebook – to keep in touch with family and/or friends 1-2 times a week	Social network: Facebook – to keep in touch with family and/or friends Rarely	Social network: Facebook – to keep in touch with family and/or friends Never
Other Social Networks like MySpace/Twitter etc. – to keep in touch with family and/or friends	Other Social Networks like MySpace/Twitter etc. – to keep in touch with family and/or friends Everyday	Other Social Networks like MySpace/Twitter etc. – to keep in touch with family and/or friends At Least 4 times a week	Other Social Networks like MySpace/Twitter etc. – to keep in touch with family and/or friends 1-2 times a week	Other Social Networks like MySpace/Twitter etc. – to keep in touch with family and/or friends Rarely	Other Social Networks like MySpace/Twitter etc. – to keep in touch with family and/or friends Never
personal blog	personal blog Everyday	personal blog At Least 4 times a week	personal blog 1-2 times a week	personal blog Rarely	personal blog Never
I read blogs / forums – to keep informed	I read blogs / forums – to keep informed Everyday	I read blogs / forums – to keep informed At Least 4 times a week	I read blogs / forums – to keep informed 1-2 times a week	I read blogs / forums – to keep informed Rarely	I read blogs / forums – to keep informed Never
E-shopping	E-shopping Everyday	E-shopping At Least 4 times a week	E-shopping 1-2 times a week	E-shopping Rarely	E-shopping Never
Listen to music (streaming)	Listen to music (streaming) Everyday	Listen to music (streaming) At Least 4 times a week	Listen to music (streaming) 1-2 times a week	Listen to music (streaming) Rarely	Listen to music (streaming) Never
See videos	See videos Everyday	See videos At Least 4 times a week	See videos 1-2 times a week	See videos Rarely	See videos Never
To follow my hobbies	To follow my hobbies Everyday	To follow my hobbies At Least 4 times a week	To follow my hobbies 1-2 times a week	To follow my hobbies Rarely	To follow my hobbies Never
Email/Chat	Email/Chat Everyday	Email/Chat At Least 4 times a week	Email/Chat 1-2 times a week	Email/Chat Rarely	Email/Chat Never
Other	Other Everyday	Other At Least 4 times a week	Other 1-2 times a week	Other Rarely	Other Never

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* 11. What is your contact info?

First & Last Name

City/Town

State/Province

Email Address

Phone Number