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Your Personal information Full name: Address City Zipcode State Approximately how many times did you shop for [Product] in the past year? Please indicate how much your family spent on [Product] within the last year. $0 - $50 $51 - $100 $101 - $250 $251 - $500 $501> What brand of [Product] did you purchase if any? Brand 1 Brand 2 Brand 3 Brand 4 Other How did you purchase this product? In the store Cataloge Internet Direct Mail Other How satisfied are you with the product? Very satisfied Satisfied Somewhat Satisfied Disatisfied Very disatisfied What would make the product better in your opinion? Please explain what you would like to see changed. Would you consider buying a similar product within a year? Yes No Not sure yet