- Type of Store Where Purchased:
 
		
		- How did you first become aware of this product?:
 
		
		- What factors most influenced your purchase?:
 
		(Please select all that applies)
		
		- This product is:
 
		
		- What other brands did you consider?:
 
		
		- Which of the following products do you:
 
		
		- Ethnicity:
 
		
		- You are:
 
		
		- Annual Household Income:
 
		
		- Any Comments?: