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Customer Information
Name
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Address
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Address 2
City, State or Prov., Zip
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Home Phone
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Work Phone
Email Address
Date of Purchase
January
February
March
April
May
June
July
August
September
October
November
December
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
2001
2002
2003
2004
2005
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Product Purchased
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Retail Purchase Price
(excluding tax and delivery)
Where did you buy your grill
Hearth Specialty Shop
Local Hardware Store
LP Gas Supplier
Home Improvment Warehouse
Major Chain Store
Lawn & Garden Center
Deck Contractor / Builder
Internet or Mail Order
Retailer Name and Address
How would you rank your grill against other grills
Great!
Good
Same
Fair
Poor
How did you first hear about your grill?
Magazine Type
Sports
Food
Financial
Men's
Women's
Newspaper Ad
Local Dealer
Importer
Distributor
Demonstration
Home Show
Fair
Expo
Retail Store
Recommendation
Friend
Neighbor
Relative
Internet
(What search engine?)
What Kind of BBQ grill did you replace?
Charcoal
Gas
Electric
How old was your previous grill?
How often do you cook outdoors?
All Year
9 months
6 months
3 months
Tell us something about yourself?
What age group best describes you
65 & over
55-64
45-54
35-44
under 35
How many adults in your household
4 or more
3 adults
couple
single
What best describes your household income
+$25K
+$40K
+$60K
+$80K
$100K up
Highest level of education attained
College grad
College
H.S. Grad
Some H.S.
Principal Occupation
Professional
Technical
Management
Self-employed
Retired
Military
Other
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required fields
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Sunshine Grills All Rights Reserved 2003
Reale & Associates