Product Booklet: Wave 75

Transcription

label
Interview #
(1-6)
C
D
NAME
1
䡺
7
DATE
Survey of the
American Consumer
75
IF THIS BOOKLET IS NOT PICKED
UP WITHIN TWO WEEKS FROM
DATE RECEIVED, PLEASE CALL:
AMERICAN INSTITUTE OF CONSUMER STUDIES
1-800-442-0925
AICSINFO.COM
Dear Survey Member:
You have been selected to participate in an important consumer research study. We would like to thank
you in advance for taking part. In order for the study to succeed and fulfill its intended purpose, which is to provide
information to manufacturers as to consumer preference of products and services, every question must
be answered. Your answers will be grouped with 10,000 other people’s who have taken the time to fill out this
questionnaire. This will help us provide a complete and accurate picture for manufacturers and will enable them
to produce and advertise more effectively the kinds of products people want. As your answers are tabulated by
computer, your individual responses are kept strictly confidential.
You are to complete the first section of this booklet. The second section, beginning with page 87, is to be
completed by the person who does most of the shopping for groceries and household items. If that is you, please
continue and complete the second section. If that is not you, please have the person who does most of the
shopping fill out the second section.
Once again, we appreciate your help and cooperation.
Sincerely,
American Institute of Consumer Studies
The first section of this booklet (Pages 1-86) is to be completed by the person who was interviewed:
First Name
Last Name
Please record the date you started filling out this booklet.
Month
Day
Year
Copyright © 2016 GfK Mediamark Research & Intelligence, LLC. All rights reserved. This work is comprised of confidential and copyrighted material and is the property
of GfK Mediamark Research & Intelligence, LLC. No part of this work may be used, distributed, sold, revealed, reproduced, or transmitted in any form or by any means,
electronic or mechanical, including photocopy recording or any information storage and retrieval system now known or to be invented, without the prior written
permission of GfK Mediamark Research & Intelligence, LLC.
INSTRUCTIONS
Page 1
In order that you may complete this booklet easily and quickly, please read and
follow these simple instructions.
1. For each product place an “X” in the box beside the word “TOTAL” if you have
used that product in the last 6 months.
If you have not used the product in the last 6 months, leave the box blank and go
to the next product.
2. For each type, etc. (if any), place an “X” in the box beside the type, etc. you have
used.
3. Place an “X” beside each brand name used. If you have used a brand that is not
listed, write in the name and mark the box.
4. On the line beside “TOTAL” write in the number used in the specified time period.
The time period differs for each product category, so please read each heading
very carefully.
5. Then enter the number of times each type, etc. (if any) was used in the specified
time period.
6. Then enter the number of times each brand was used in the specified time
period.
IF YOU HAVE USED NONE IN THE SPECIFIED TIME PERIOD ENTER “0”.
IF YOU DON’T KNOW EXACT QUANTITIES PLEASE ESTIMATE AS BEST YOU
CAN.
The total number of times brands were used should add to the “TOTAL” at the top of
the column.
The total number of times types, etc. were used should add to the “TOTAL” at the
top of the column.
TOOTHPASTE
You Personally:
Used in
Times/
last 6
last 7
months
days
001
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Baking Soda. . . . . . . . . . . . .
Non Baking Soda . . . . . . . . .
KINDS:
Tartar Control . . . . . . . . . . . .
Regular. . . . . . . . . . . . . . . . .
FORMS:
Gel . . . . . . . . . . . . . . . . . . . .
Paste . . . . . . . . . . . . . . . . . .
BRANDS:
Aim . . . . . . . . . . . . . . . . . . . .
Aquafresh . . . . . . . . . . . . . . .
Aquafresh Extreme Clean . .
Aquafresh Whitening . . . . . .
Arm & Hammer Advance
White. . . . . . . . . . . . . . . . .
Other Arm & Hammer. . . . . .
Closeup . . . . . . . . . . . . . . . .
Colgate 2in1 . . . . . . . . . . . . .
Colgate Max Fresh . . . . . . . .
Colgate Optic White . . . . . . .
Colgate Regular . . . . . . . . . .
Colgate Sensitive . . . . . . . . .
Colgate Sparkling White . . . .
Colgate Tartar Protection . . .
Colgate Total. . . . . . . . . . . . .
Colgate Total Advanced . . . .
Colgate Baking Soda and
Peroxide Whitening . . . . . .
Other Colgate . . . . . . . . . . . .
Crest Complete . . . . . . . . . .
Crest Pro-Health. . . . . . . . . .
Crest Regular Gel. . . . . . . . .
Crest Regular Paste . . . . . . .
Crest Sensitivity . . . . . . . . . .
Crest Tartar Protection . . . . .
Crest 3D White . . . . . . . . . . .
Crest Whitening Plus Scope
Other Crest . . . . . . . . . . . . .
Pepsodent . . . . . . . . . . . . . .
Rembrandt . . . . . . . . . . . . . .
Sensodyne . . . . . . . . . . . . . .
Sensodyne ProNamel. . . . . .
Tom’s of Maine . . . . . . . . . . .
Ultrabrite. . . . . . . . . . . . . . . .
Store’s Own Brand . . . . . . . .
OTHER (Write In)
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
999
PROPERTIES:
116-0
Whitening . . . . . . . . . . . . . . . 1
Sensitive. . . . . . . . . . . . . . . . 2
This example indicates that this person:
— used toothpaste in the last 6 months
— used baking soda in the last 6 months
— used non-baking soda in the last 6 months
— used regular in the last 6 months
— used paste in the last 6 months
— used Colgate with Baking Soda and Peroxide
Whitening and Smerb in the last 6 months
— used toothpaste 14 times in the last 7 days
— used baking soda 6 times in the last 7 days
— used non-baking soda 8 times in the last
7 days
— used regular 14 times in the last 7 days
— used paste 14 times in the last 7 days
— used Colgate with Baking Soda and Peroxide
Whitening 6 times and Smerb 8 times in the last
7 days
75
Page 2
The questions on this page refer to places in your area where you might shop. After completing this page, please continue with the rest of the
questionnaire.
FOOD/WAREHOUSE/
CLUB STORES
You Personally:
Shopped
in last 6
months
67A
Grocery Stores:
Acme . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Albertsons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Aldi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
BI-LO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Cub Foods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Food Lion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Fred Meyer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
GNC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Giant. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Giant Eagle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Hannaford. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Harris Teeter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
H-E-B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Hy-Vee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
IGA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
King Soopers . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Kroger. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Meijer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Military Commissary . . . . . . . . . . . . . . . . . . . . . . .
Piggly Wiggly . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Price Chopper . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Publix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Ralphs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Safeway . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Save-A-Lot . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7-Eleven . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Smith’s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Stop & Shop . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Target (grocery) . . . . . . . . . . . . . . . . . . . . . . . . . . .
Trader Joe’s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Vons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Walmart Supercenter (grocery) . . . . . . . . . . . . . . .
Wegmans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Whole Foods Market . . . . . . . . . . . . . . . . . . . . . . .
Winn-Dixie . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Warehouse/Club Stores:
BJ’s Wholesale Club. . . . . . . . . . . . . . . . . . . . . . . .
Costco Wholesale. . . . . . . . . . . . . . . . . . . . . . . . . .
Sam’s Club . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
DEPARTMENT,
CLOTHING/SHOES &
SPECIALTY STORES
Times
in last
30 days
01
02
03
04
05
11
13
15
16
17
19
20
21
22
23
27
28
29
30
33
34
35
36
37
38
39
42
44
47
49
50
51
53
54
55
56
57
58
Amount spent in grocery stores, food stores, supermarkets and
warehouse/club stores:
Amount spent by household, average week $
67M-0
Amount spent by you personally, average week $
DRUG STORES
67H
67P-0
You Personally:
Shopped
Times
last 6
in last
months
30 days
CVS Pharmacy/Longs Drugs . . . . . . . . . . . . . . . . .
Rite Aid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Target Pharmacy . . . . . . . . . . . . . . . . . . . . . . . . . .
Walmart Pharmacy. . . . . . . . . . . . . . . . . . . . . . . . .
Walgreen’s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
APPLIANCE,
HARDWARE AND
ELECTRONICS STORES
67K
01
08
10
12
13
You Personally:
Shopped
Times
last 12
in last
30 days
months
APPLIANCE AND HARDWARE STORES
Ace Hardware. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Harbor Freight Tools . . . . . . . . . . . . . . . . . . . . . . . .
Home Depot . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Lowe’s. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Sears Appliance & Hardware . . . . . . . . . . . . . . . . .
Sherwin Williams . . . . . . . . . . . . . . . . . . . . . . . . . .
Tractor Supply Company . . . . . . . . . . . . . . . . . . . .
True Value . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
02
03
04
05
08
09
10
11
Apple Store. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Best Buy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
RadioShack . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
RAC Rent-A-Center . . . . . . . . . . . . . . . . . . . . . . . .
Abercrombie & Fitch. . . . . . . . . . . . . . . . . . . . . . . .
Aéropostale . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
American Eagle Outfitters. . . . . . . . . . . . . . . . . . . .
Ann Taylor. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Banana Republic . . . . . . . . . . . . . . . . . . . . . . . . . .
Bath & Body Works . . . . . . . . . . . . . . . . . . . . . . . .
Bealls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Bed Bath & Beyond . . . . . . . . . . . . . . . . . . . . . . . .
Belk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Big Lots . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Bloomingdale’s . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The Body Shop . . . . . . . . . . . . . . . . . . . . . . . . . . .
Burlington Coat Factory . . . . . . . . . . . . . . . . . . . . .
Champs Sports . . . . . . . . . . . . . . . . . . . . . . . . . . .
Chico’s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Crate & Barrel. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
David’s Bridal . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Dick’s Sporting Goods . . . . . . . . . . . . . . . . . . . . . .
Dillard’s. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The Disney Store . . . . . . . . . . . . . . . . . . . . . . . . . .
Dollar General . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Dollar Tree . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Dress Barn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
DSW. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Eddie Bauer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Express . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Family Dollar. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Famous Footwear . . . . . . . . . . . . . . . . . . . . . . . . .
Finish Line . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Foot Action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Foot Locker. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Forever 21 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Fred’s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The Gap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
H&M . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Hallmark Gold Crown . . . . . . . . . . . . . . . . . . . . . . .
Hollister . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
HomeGoods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
J.Crew . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
JCPenney . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Jo-Ann Fabric and Craft . . . . . . . . . . . . . . . . . . . . .
Kmart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Kohl’s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Lane Bryant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
LOFT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Lord & Taylor . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Macy’s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Marshalls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Men’s Wearhouse. . . . . . . . . . . . . . . . . . . . . . . . . .
Michaels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Military Exchange . . . . . . . . . . . . . . . . . . . . . . . . . .
Neiman Marcus . . . . . . . . . . . . . . . . . . . . . . . . . . .
New York & Company. . . . . . . . . . . . . . . . . . . . . . .
Nordstrom. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Old Navy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
PacSun. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Payless . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Pier 1 Imports. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Pottery Barn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Ross Stores . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Saks Fifth Avenue. . . . . . . . . . . . . . . . . . . . . . . . . .
Sears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Sephora . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Shoe Carnival. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Sports Authority . . . . . . . . . . . . . . . . . . . . . . . . . . .
Talbots . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Target . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
T.J. Maxx . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Toys “R” Us . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Ulta. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Victoria’s Secret . . . . . . . . . . . . . . . . . . . . . . . . . . .
Walmart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Williams-Sonoma . . . . . . . . . . . . . . . . . . . . . . . . . .
OFFICE/COMPUTER
SUPPLY STORES
67W
ELECTRONICS STORES
67F
01
02
06
07
You Personally:
Shopped
Times
last 3
in last
months
30 days
67X
01
02
03
04
06
07
08
09
10
12
13
14
15
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
47
48
49
50
51
52
54
55
56
57
58
59
60
61
62
64
65
67
68
69
70
71
72
74
75
76
77
78
79
80
81
You Personally:
Shopped
Times
last 12
in last
months
30 days
FedEx Office. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Office Depot . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
OfficeMax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Staples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
01
02
03
04
HEALTH, ANTICAVITY AND BEAUTY AIDS
Page 3
TOOTHPASTE
You Personally:
Used in
Times/
last 6
last 7
months
days
TOOTHBRUSHES
001
OTHER (Write In)
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
999
PROPERTIES:
116-0
Whitening . . . . . . . . . . . . . . . 1
Sensitive. . . . . . . . . . . . . . . . 2
You Personally:
Used in
Times/
last 6
last 7
months
days
002
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Waxed . . . . . . . . . . . . . . . . .
Unwaxed . . . . . . . . . . . . . . .
KINDS:
Flavored . . . . . . . . . . . . . . . .
Unflavored . . . . . . . . . . . . . .
BRANDS:
Aim . . . . . . . . . . . . . . . . . . . .
DenTek . . . . . . . . . . . . . . . . .
G-U-M . . . . . . . . . . . . . . . . .
Johnson & Johnson Reach .
Listerine . . . . . . . . . . . . . . . .
Oral-B Complete. . . . . . . . . .
Oral-B Glide . . . . . . . . . . . . .
Plackers . . . . . . . . . . . . . . . .
OTHER (Write In)
MOUTHWASH/
DENTAL RINSE
003
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Baking Soda. . . . . . . . . . . . .
Non Baking Soda . . . . . . . . .
KINDS:
Tartar Control . . . . . . . . . . . .
Regular. . . . . . . . . . . . . . . . .
FORMS:
Gel . . . . . . . . . . . . . . . . . . . .
Paste . . . . . . . . . . . . . . . . . .
BRANDS:
Aim . . . . . . . . . . . . . . . . . . . .
Aquafresh . . . . . . . . . . . . . . .
Aquafresh Extreme Clean . .
Aquafresh Whitening . . . . . .
Arm & Hammer Advance
White. . . . . . . . . . . . . . . . .
Other Arm & Hammer. . . . . .
Closeup . . . . . . . . . . . . . . . .
Colgate 2in1 . . . . . . . . . . . . .
Colgate Max Fresh . . . . . . . .
Colgate Optic White . . . . . . .
Colgate Regular . . . . . . . . . .
Colgate Sensitive . . . . . . . . .
Colgate Sparkling White . . . .
Colgate Tartar Protection . . .
Colgate Total. . . . . . . . . . . . .
Colgate Total Advanced . . . .
Colgate Baking Soda and
Peroxide Whitening . . . . . .
Other Colgate . . . . . . . . . . . .
Crest Complete . . . . . . . . . .
Crest Pro-Health. . . . . . . . . .
Crest Regular Gel. . . . . . . . .
Crest Regular Paste . . . . . . .
Crest Sensitivity . . . . . . . . . .
Crest Tartar Protection . . . . .
Crest 3D White . . . . . . . . . . .
Crest Whitening Plus Scope
Other Crest . . . . . . . . . . . . .
Pepsodent . . . . . . . . . . . . . .
Rembrandt . . . . . . . . . . . . . .
Sensodyne . . . . . . . . . . . . . .
Sensodyne ProNamel. . . . . .
Tom’s of Maine . . . . . . . . . . .
Ultrabrite. . . . . . . . . . . . . . . .
DENTAL FLOSS
You Personally:
Bought
Number
in last 6
in last 6
months
months
00
01
02
03
04
TOTAL:
006
................. TYPES:
Battery-Operated . . . . . . . . . Electric . . . . . . . . . . . . . . . . . Manual . . . . . . . . . . . . . . . . . KINDS:
Firm Bristle . . . . . . . . . . . . . . Medium Bristle . . . . . . . . . . . Soft Bristle . . . . . . . . . . . . . . FORMS:
Angled Handle . . . . . . . . . . . Straight Handle . . . . . . . . . . BRANDS:
Colgate 360˚. . . . . . . . . . . . .
Colgate Plus . . . . . . . . . . . . .
Colgate Total Professional . .
Colgate Wave . . . . . . . . . . . .
Other Colgate . . . . . . . . . . . .
G-U-M . . . . . . . . . . . . . . . . .
Oral-B Advantage . . . . . . . . .
Oral-B CrossAction. . . . . . . .
Oral-B Deep Sweep . . . . . . .
Oral-B Indicator . . . . . . . . . .
Oral-B Pro-Health . . . . . . . . .
Oral-B ProfessionalCare. . . .
Oral-B Pulsar . . . . . . . . . . . .
Oral-B Vitality . . . . . . . . . . . .
Other Oral-B. . . . . . . . . . . . .
Reach Advanced Design . . .
Reach Total Care . . . . . . . . .
Other Reach . . . . . . . . . . . . .
Sonicare . . . . . . . . . . . . . . . .
Spinbrush . . . . . . . . . . . . . . .
Store’s Own Brand . . . . . . . . 00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
21
22
23
24
25
26
27
28
29
999
You Personally:
Used in
Times/
last 6
last 7
months
days
008
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Blistex. . . . . . . . . . . . . . . . . .
Burt’s Bees. . . . . . . . . . . . . .
Carmex. . . . . . . . . . . . . . . . .
ChapStick Classic . . . . . . . .
ChapStick Hydration Lock . .
ChapStick Lip Moisturizer. . .
Other ChapStick . . . . . . . . . .
eos . . . . . . . . . . . . . . . . . . . .
Herpecin L . . . . . . . . . . . . . .
Maybelline Baby Lips . . . . . .
Neutrogena. . . . . . . . . . . . . .
Nivea . . . . . . . . . . . . . . . . . .
Softlips . . . . . . . . . . . . . . . . .
Vaseline Lip Therapy . . . . . .
Other Vaseline . . . . . . . . . . .
OTHER (Write In)
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
ACT Anticavity Fluoride . . . .
ACT Restoring . . . . . . . . . . .
ACT Total Care . . . . . . . . . . .
Other ACT Rinse . . . . . . . . .
Biotène . . . . . . . . . . . . . . . . .
Cepacol . . . . . . . . . . . . . . . .
Colgate . . . . . . . . . . . . . . . . .
Crest Pro-Health Rinse. . . . .
Crest 3D White Rinse . . . . . .
Lavoris . . . . . . . . . . . . . . . . .
Listerine (Yellow) . . . . . . . . .
Listerine Cool Mint (Blue) . . .
Listerine FreshBurst (Green)
Listerine Healthy White . . . .
Listerine Total Care . . . . . . .
Listerine Ultraclean. . . . . . . .
Listerine Zero . . . . . . . . . . . .
Other Listerine . . . . . . . . . . .
Scope Original (Green) . . . .
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
999
10
11
12
13
999
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
999
OTHER (Write In)
BREATH
FRESHENERS
You Personally:
Used in
Times/
last 6
last 7
months
days
007
00
01
02
03
04
05
06
07
08
09
10
Sweet Breath . . . . . . . . . . . . 11
999
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Spray/Drops . . . . . . . . . . . . .
Mints. . . . . . . . . . . . . . . . . . .
Gum . . . . . . . . . . . . . . . . . . .
Liquid . . . . . . . . . . . . . . . . . .
Thin Film. . . . . . . . . . . . . . . .
BRANDS:
Binaca . . . . . . . . . . . . . . . . .
Cool Mint Listerine
PocketPaks Strips. . . . . . .
Other Listerine
PocketPaks Strips. . . . . . .
Listerine Pocketmist . . . . . . .
MintAsure . . . . . . . . . . . . . . .
OTHER (Write In)
TOOTH
WHITENERS
(not toothpaste)
You Personally:
Used in
Times/
last 6
last 7
months
days
004
TOTAL: . . . . . . . . . . . . . . . . .
FORMS:
Strips . . . . . . . . . . . . . . . . . .
Gel . . . . . . . . . . . . . . . . . . . .
Trays . . . . . . . . . . . . . . . . . . .
BRANDS:
Crest 3D White Whitestrips. .
Plus White . . . . . . . . . . . . . .
Rembrandt . . . . . . . . . . . . . .
OTHER (Write In)
05
06
07
08
09
Scope Outlast. . . . . . . . . . . . Tom’s of Maine . . . . . . . . . . . 20
OTHER (Write In)
LIP CARE
You Personally:
Used in
Times/
last 6
last 7
months
days
00
01
02
03
04
05
06
999
HEALTH AND BEAUTY AIDS
DEODORANTS AND
ANTIPERSPIRANTS
You Personally:
Used in
Times/
last 6
last 7
months
days
COMPLEXION CARE
PRODUCTS
(Facial Cleansers,
Facial Toners, etc.)
010
TOTAL:
You Personally:
Used in
Times/
last 6
last 7
months
days
HAND & BODY
CREAM, LOTION OR
OIL
011
................. TYPES:
Scented . . . . . . . . . . . . . . . . Unscented . . . . . . . . . . . . . . KINDS:
Antiperspirant/Deodorant . . . Deodorant Only . . . . . . . . . . Antiperspirant Only . . . . . . . . BRANDS:
Adidas. . . . . . . . . . . . . . . . . .
Arm & Hammer Stick/Solid . .
Arrid Extra Dry Clear Gel . . . .
Arrid Extra Dry Spray . . . . . . .
Arrid XX Roll-On . . . . . . . . . .
Arrid XX Solid . . . . . . . . . . . .
Arrid XX Spray. . . . . . . . . . . .
Avon . . . . . . . . . . . . . . . . . . .
Axe Stick. . . . . . . . . . . . . . . .
Ban Roll-On . . . . . . . . . . . . .
Ban Solid . . . . . . . . . . . . . . .
Brut Spray . . . . . . . . . . . . . .
Brut Stick . . . . . . . . . . . . . . .
Degree Clinical Protection . .
Degree Women Stick . . . . . .
Degree Women Spray . . . . .
Degree Women Ultra Clear .
Degree Men Spray . . . . . . . .
Degree Men Stick . . . . . . . .
Dove Clinical Protection . . . .
Dove Men+Care . . . . . . . . . .
Dove Roll-On . . . . . . . . . . . .
Dove Solid . . . . . . . . . . . . . .
Dove Spray. . . . . . . . . . . . . .
Dry Idea . . . . . . . . . . . . . . . .
Gillette Clinical . . . . . . . . . . .
Gillette Clear Gel . . . . . . . . .
Gillette Solid . . . . . . . . . . . . .
Lady Speed Stick . . . . . . . . .
Lady Speed Stick 24/7 . . . . .
Mitchum Gel . . . . . . . . . . . . .
Mitchum Roll-On. . . . . . . . . .
Mitchum Solid. . . . . . . . . . . .
Mitchum for Women . . . . . . .
Old Spice High Endurance. .
Old Spice Red Zone . . . . . . .
Old Spice Stick . . . . . . . . . . .
Power Stick. . . . . . . . . . . . . .
Right Guard Sport Gel . . . . .
Right Guard Sport Spray . . .
Right Guard Sport Solid . . . .
Right Guard Total Defense 5 .
Secret Clear Gel. . . . . . . . . .
Secret Clinical Strength . . . .
Secret Invisible Solid . . . . . .
Secret Outlast. . . . . . . . . . . .
Secret Roll-On . . . . . . . . . . .
Secret Solid . . . . . . . . . . . . .
Secret Spray. . . . . . . . . . . . .
Soft & Dri . . . . . . . . . . . . . . .
Speed Stick . . . . . . . . . . . . .
Suave . . . . . . . . . . . . . . . . . .
Sure Solid. . . . . . . . . . . . . . .
Sure Spray . . . . . . . . . . . . . .
Tom’s of Maine . . . . . . . . . . .
OTHER (Write In)
Page 4
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
999
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Astringent . . . . . . . . . . . . . . .
Cleansers . . . . . . . . . . . . . . .
Toner . . . . . . . . . . . . . . . . . .
FORMS:
Cloths/Towelettes . . . . . . . . .
Mask. . . . . . . . . . . . . . . . . . .
Pad . . . . . . . . . . . . . . . . . . . .
Sponge. . . . . . . . . . . . . . . . .
KINDS:
Bar . . . . . . . . . . . . . . . . . . . .
Cream. . . . . . . . . . . . . . . . . .
Gel . . . . . . . . . . . . . . . . . . . .
Lotion . . . . . . . . . . . . . . . . . .
Scrub . . . . . . . . . . . . . . . . . .
BRANDS:
Almay . . . . . . . . . . . . . . . . . .
Aveeno . . . . . . . . . . . . . . . . .
Avon Clearskin . . . . . . . . . . .
Other Avon . . . . . . . . . . . . . .
Bioré . . . . . . . . . . . . . . . . . . .
Bioré Deep Cleansing
Pore Strips . . . . . . . . . . . .
Burt’s Bees. . . . . . . . . . . . . .
Cetaphil . . . . . . . . . . . . . . . .
Clean & Clear Advantage . . .
Clean & Clear Morning Burst .
Other Clean & Clear. . . . . . .
Clearasil Daily Face Wash . .
Clearasil Ultra. . . . . . . . . . . .
Other Clearasil . . . . . . . . . . .
Clinique Facial Soap . . . . . .
Other Clinique . . . . . . . . . . .
Estée Lauder . . . . . . . . . . . .
Garnier . . . . . . . . . . . . . . . . .
Lancôme . . . . . . . . . . . . . . .
L’Oréal . . . . . . . . . . . . . . . . .
Mary Kay . . . . . . . . . . . . . . .
Neutrogena Deep Clean
Cleanser . . . . . . . . . . . . . .
Neutrogena Naturals . . . . . .
Neutrogena Oil-Free Acne
Wash. . . . . . . . . . . . . . . . .
Neutrogena Pore Refining . .
Other Neutrogena. . . . . . . . .
Nivea Men . . . . . . . . . . . . . .
Noxzema Cleansing Cream
Olay Daily Facial Cloths . . . .
Olay Foaming Face Wash . .
Olay ProX . . . . . . . . . . . . . . .
Olay Regenerist . . . . . . . . . .
Olay Total Effects . . . . . . . . .
Other Olay . . . . . . . . . . . . . .
Oxy. . . . . . . . . . . . . . . . . . . .
philosophy . . . . . . . . . . . . . .
Pond’s Cold Cream. . . . . . . .
Pond’s Towelettes . . . . . . . . .
Proactiv. . . . . . . . . . . . . . . . .
RoC . . . . . . . . . . . . . . . . . . .
Sea Breeze Astringent . . . . .
Simple . . . . . . . . . . . . . . . . .
St. Ives Apricot Scrub . . . . . .
Other St. Ives . . . . . . . . . . . .
Stridex . . . . . . . . . . . . . . . . .
013
................. 00
TOTAL:
01
02
03
TYPES:
Cream. . . . . . . . . . . . . . . . . .
Lotion . . . . . . . . . . . . . . . . . .
Oil. . . . . . . . . . . . . . . . . . . . .
Spray . . . . . . . . . . . . . . . . . .
04
05
06
07
08
09
10
11
12
13
14
15
16
17
OTHER (Write In)
Facial skin type:
Dry . . . . . . . . . . . . . . . . . . . .
Normal . . . . . . . . . . . . . . . . .
Oily . . . . . . . . . . . . . . . . . . . .
Partly oily/partly dry . . . . . . .
Sensitive. . . . . . . . . . . . . . . .
You Personally:
Used in
Times/
last 6
last 7
months
days
012-0
1
2
3
4
5
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
999
BRANDS:
Aquaphor Ointment . . . . . . .
Aveeno Daily Moisturizing . .
Other Aveeno . . . . . . . . . . . .
Avon . . . . . . . . . . . . . . . . . . .
Baby Magic Baby Lotion. . . .
Bath & Body Works . . . . . . .
The Body Shop. . . . . . . . . . .
Burt’s Bees. . . . . . . . . . . . . .
Carmex. . . . . . . . . . . . . . . . .
Cetaphil . . . . . . . . . . . . . . . .
Curél . . . . . . . . . . . . . . . . . . .
Dermasil . . . . . . . . . . . . . . . .
Dial 7 Day. . . . . . . . . . . . . . .
Dove . . . . . . . . . . . . . . . . . . .
eos . . . . . . . . . . . . . . . . . . . .
Eucerin Original . . . . . . . . . .
Eucerin Intensive Repair . . .
Other Eucerin . . . . . . . . . . . .
Gold Bond Medicated Lotion
Gold Bond Ultimate Lotion . .
Jergens Natural Glow. . . . . .
Jergens Original Scent . . . . .
Jergens Skin Firming . . . . . .
Jergens Ultra Healing. . . . . .
Other Jergens. . . . . . . . . . . .
Johnson’s Baby Lotion . . . . .
Johnson’s Baby Oil . . . . . . . .
Other Johnson’s . . . . . . . . . .
Keri Lotion . . . . . . . . . . . . . .
Kiss My Face . . . . . . . . . . . .
L’Oréal . . . . . . . . . . . . . . . . .
Lubriderm Advanced
Therapy. . . . . . . . . . . . . . .
Lubriderm Daily Moisture . . .
Lubriderm Intense Skin
Repair . . . . . . . . . . . . . . . .
Lubriderm Sensitive Skin . . .
Mary Kay . . . . . . . . . . . . . . .
Neutrogena Hand Cream . . .
Neutrogena Body Lotion. . . .
Neutrogena Body Oil . . . . . .
Nivea Smooth Sensation . . .
Other Nivea . . . . . . . . . . . . .
O’Keeffe’s Working Hands . .
Olay Quench . . . . . . . . . . . .
Olay Ultra Moisture. . . . . . . .
Other Olay . . . . . . . . . . . . . .
Palmer’s . . . . . . . . . . . . . . . .
Sally Hansen . . . . . . . . . . . .
St. Ives . . . . . . . . . . . . . . . . .
Suave . . . . . . . . . . . . . . . . . .
Vaseline Advanced Repair . .
Vaseline Aloe Soothe . . . . . .
Vaseline Cocoa Butter . . . . .
Vaseline Essential Healing . .
Vaseline Men . . . . . . . . . . . .
Vaseline Petroleum Jelly. . . .
Other Vaseline . . . . . . . . . . .
OTHER (Write In)
Used for:
Anti-Aging . . . . . . . . . . . . . .
Anti-Cellulite/Firming . . . . . .
Dry Skin . . . . . . . . . . . . . . . .
Moisturizing . . . . . . . . . . . . .
Self Tan/Glow . . . . . . . . . . . .
Sensitive Skin. . . . . . . . . . . .
014-0
1
2
3
4
5
6
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
999
Page 5
PERSONAL CARE
SOAPS – BAR
You Personally:
Used in
Times/
last 6
last 30
months
days
LIQUID SOAPS/
HAND SANITIZERS
015
01
02
03
04
05
Dove . . . . . . . . . . . . . . . . . . .
Dove Men+Care . . . . . . . . . .
Dove Sensitive Skin . . . . . . .
Irish Spring Original . . . . . . .
Irish Spring Aloe . . . . . . . . . .
06
07
08
09
10
Ivory . . . . . . . . . . . . . . . . . . .
Jergens. . . . . . . . . . . . . . . . .
Lava . . . . . . . . . . . . . . . . . . .
Lever 2000 . . . . . . . . . . . . . .
Neutrogena. . . . . . . . . . . . . .
11
12
13
14
15
Olay . . . . . . . . . . . . . . . . . . .
Old Spice . . . . . . . . . . . . . . .
Palmolive . . . . . . . . . . . . . . .
Safeguard. . . . . . . . . . . . . . .
Softsoap Bar. . . . . . . . . . . . .
16
17
18
19
20
Tone . . . . . . . . . . . . . . . . . . .
Yardley . . . . . . . . . . . . . . . . .
Zest . . . . . . . . . . . . . . . . . . .
21
22
23
24
999
00
021
Used for:
Antibacterial . . . . . . . . . . . . .
Complexion . . . . . . . . . . . . .
Deodorant . . . . . . . . . . . . . .
Moisturizing . . . . . . . . . . . . .
03
04
05
06
07
08
09
10
11
12
Jergens. . . . . . . . . . . . . . . . .
Lava Soap . . . . . . . . . . . . . .
Lysol No-Touch. . . . . . . . . . .
Method . . . . . . . . . . . . . . . .
Mrs. Meyer’s . . . . . . . . . . . . .
OTHER (Write In)
13
14
15
16
999
You Personally:
Used in
Times/
last 6
last 7
months
days
020
TYPES:
Baby . . . . . . . . . . . . . . . . . . .
Color Treated . . . . . . . . . . . .
Fine Hair/Extra Body . . . . . .
Dry Hair . . . . . . . . . . . . . . . .
Frizzy Hair . . . . . . . . . . . . . .
Oily Hair . . . . . . . . . . . . . . . .
Medicated/Dandruff . . . . . . .
Normal Hair . . . . . . . . . . . . .
Permed Hair . . . . . . . . . . . . .
All Purpose . . . . . . . . . . . . . .
BRANDS:
Alberto VO5 . . . . . . . . . . . . .
Aussie. . . . . . . . . . . . . . . . . .
Aveda . . . . . . . . . . . . . . . . . .
Aveeno . . . . . . . . . . . . . . . . .
Avon . . . . . . . . . . . . . . . . . . .
Axe . . . . . . . . . . . . . . . . . . . .
Baby Magic Shampoo . . . . .
Bed Head . . . . . . . . . . . . . . .
Bumble and bumble . . . . . . .
01
02
03
04
05
06
Clear Scalp & Hair . . . . . . . .
Dark & Lovely . . . . . . . . . . . .
Denorex . . . . . . . . . . . . . . . .
Dove . . . . . . . . . . . . . . . . . . .
Finesse. . . . . . . . . . . . . . . . .
07
08
09
10
Garnier Fructis . . . . . . . . . . .
Güd . . . . . . . . . . . . . . . . . . .
Head & Shoulders . . . . . . . .
Herbal Essences . . . . . . . . .
Infusium 23. . . . . . . . . . . . . .
01
02
03
04
05
Bed Head . . . . . . . . . . . . . . .
Biolage by Matrix . . . . . . . . .
Bumble and bumble . . . . . . .
Clear Scalp & Hair . . . . . . . .
Dark & Lovely. . . . . . . . . . . .
12
13
14
15
16
John Frieda Brilliant Brunette
John Frieda Frizz Ease . . . . .
John Frieda Sheer Blonde. . .
Johnson’s Baby Shampoo . .
L’Oréal . . . . . . . . . . . . . . . . .
06
07
08
09
10
Dove . . . . . . . . . . . . . . . . . . .
Finesse. . . . . . . . . . . . . . . . .
Garnier Fructis . . . . . . . . . . .
Infusium 23. . . . . . . . . . . . . .
17
18
19
20
21
Mane ’n Tail . . . . . . . . . . . . .
Matrix . . . . . . . . . . . . . . . . . .
Motions. . . . . . . . . . . . . . . . .
Neutrogena . . . . . . . . . . . . .
Neutrogena T/Gel . . . . . . . . .
11
12
13
14
15
John Frieda Brilliant Brunette
John Frieda Frizz Ease . . . . .
John Frieda Sheer Blonde. . .
L’Oréal . . . . . . . . . . . . . . . . .
Matrix . . . . . . . . . . . . . . . . . .
22
23
24
25
26
Nexxus . . . . . . . . . . . . . . . . .
OGX . . . . . . . . . . . . . . . . . . .
Pantene Pro-V . . . . . . . . . . .
Paul Mitchell . . . . . . . . . . . . .
Pert Plus. . . . . . . . . . . . . . . .
16
17
Motions. . . . . . . . . . . . . . . . .
Neutrogena Conditioner . . . .
Nexxus . . . . . . . . . . . . . . . . .
OGX . . . . . . . . . . . . . . . . . . .
Pantene Pro-V . . . . . . . . . . .
27
28
29
30
31
Paul Mitchell . . . . . . . . . . . . .
Redken . . . . . . . . . . . . . . . . .
Suave . . . . . . . . . . . . . . . . . .
TRESemmé . . . . . . . . . . . . .
Ultra Sheen . . . . . . . . . . . . .
Pert Plus Anti-Dandruff. . . . .
Prell . . . . . . . . . . . . . . . . . . .
Redken . . . . . . . . . . . . . . . . .
Selsun blue. . . . . . . . . . . . . .
Suave . . . . . . . . . . . . . . . . . .
32
33
34
35
36
Suave Men . . . . . . . . . . . . . .
TRESemmé . . . . . . . . . . . . .
Vidal Sassoon Pro Series . . .
White Rain . . . . . . . . . . . . . .
Vidal Sassoon Pro Series . . . White Rain Conditioner. . . . . 37
38
999
4
019
01
02
00
016-0
1
2
3
FORMS:
Shampoo . . . . . . . . . . . . . . . Shampoo plus Conditioner . . Dry Shampoo . . . . . . . . . . . . You Personally:
Used in
Times/
last 6
last 30
months
days
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Aveeno Body Wash . . . . . . .
Avon . . . . . . . . . . . . . . . . . . .
Axe Shower Gel . . . . . . . . . .
Burt’s Bees. . . . . . . . . . . . . .
Caress . . . . . . . . . . . . . . . . .
Clean & Clear. . . . . . . . . . . .
Coast . . . . . . . . . . . . . . . . . .
Dial . . . . . . . . . . . . . . . . . . . .
Dial for Men . . . . . . . . . . . . .
Dove Body Wash . . . . . . . . .
Dove Men+Care . . . . . . . . . .
Gillette . . . . . . . . . . . . . . . . .
Gold Bond Ultimate . . . . . . .
Irish Spring . . . . . . . . . . . . . .
Ivory Body Wash . . . . . . . . .
Lever 2000 . . . . . . . . . . . . . .
Neutrogena. . . . . . . . . . . . . .
Nivea . . . . . . . . . . . . . . . . . .
Olay . . . . . . . . . . . . . . . . . . .
Old Spice High Endurance. .
Old Spice Red Zone . . . . . . .
Right Guard Total Defense 5
Softsoap Body Wash . . . . . .
St. Ives Body Wash . . . . . . .
Suave Body Wash . . . . . . . .
Suave Men . . . . . . . . . . . . . .
Tone Body Wash. . . . . . . . . .
White Rain Body Wash. . . . .
Zest . . . . . . . . . . . . . . . . . . .
TOTAL:
Purell . . . . . . . . . . . . . . . . . .
Softsoap . . . . . . . . . . . . . . . .
Tone . . . . . . . . . . . . . . . . . . .
................. 00
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Liquid Soap . . . . . . . . . . . . .
Hand Sanitizer . . . . . . . . . . .
BRANDS:
Avon . . . . . . . . . . . . . . . . . . .
Dial . . . . . . . . . . . . . . . . . . . .
Dial Complete. . . . . . . . . . . .
Germ-X. . . . . . . . . . . . . . . . .
Gold Bond Ultimate . . . . . . .
HAIR CONDITIONERS
(For use at home)
You Personally:
Used in
Times/
last 6
last 7
months
days
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Dry . . . . . . . . . . . . . . . . . . . .
Extra Dry . . . . . . . . . . . . . . .
Fine Hair/Extra Body . . . . . .
Frizzy . . . . . . . . . . . . . . . . . .
Normal . . . . . . . . . . . . . . . . .
Oily . . . . . . . . . . . . . . . . . . . .
BRANDS:
Alberto VO5 . . . . . . . . . . . . .
Aussie. . . . . . . . . . . . . . . . . .
Aveda . . . . . . . . . . . . . . . . . .
Aveeno . . . . . . . . . . . . . . . . .
Avon . . . . . . . . . . . . . . . . . . .
OTHER (Write In)
OTHER (Write In)
SHAMPOO
BODY
WASH/
(For
use at GEL
home)
SHOWER
017
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Aveeno . . . . . . . . . . . . . . . . .
Caress . . . . . . . . . . . . . . . . .
Coast . . . . . . . . . . . . . . . . . .
Dial Mountain Fresh . . . . . . .
Dial . . . . . . . . . . . . . . . . . . .
BODY WASH/
SHOWER GEL
You Personally:
Used in
Times/
last 6
last 30
months
days
00
18
19
20
21
22
23
24
25
26
27
28
29
30
31
999
OTHER (Write In)
11
OTHER (Write In)
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
999
HAIR CONDITIONING
TREATMENT
(For use at home)
You Personally:
Used in
Times/
last 6
last 30
months
days
HAIR SPRAYS
(For use at home)
022
OTHER (Write In)
00
01
02
03
04
05
06
07
08
09
10
11
999
You Personally:
Used in
Times/
last 6
last 6
months
months
023
00
01
02
03
04
05
06
07
08
09
10
11
12
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Temporary Rinse . . . . . . . . .
Semi-Permanent Color. . . . .
Permanent Color . . . . . . . . .
Frost, Tip, Streak Kit . . . . . . .
Bleach or Lightener . . . . . . .
FORMS:
Liquid/Lotion. . . . . . . . . . . . .
Mousse/Foam. . . . . . . . . . . .
BRANDS:
Aloxxi . . . . . . . . . . . . . . . . . .
Clairol Natural Instincts . . . .
Clairol Nice ’n Easy . . . . . . .
Other Clairol . . . . . . . . . . . . .
Dark & Lovely . . . . . . . . . . . .
Garnier Nutrisse. . . . . . . . . .
Garnier Olia . . . . . . . . . . . . .
Grecian Formula. . . . . . . . . .
John Frieda Precision Foam
Just for Men Haircolor . . . . . .
Just for Men–Autostop . . . . .
Just for Men–Must. & Beard . .
Just for Men–Touch of Gray . .
L’Oréal Excellence . . . . . . . .
18
19
20
21
22
L’Oréal Féria . . . . . . . . . . . . .
L’Oréal Preference . . . . . . . .
L’Oréal Root Rescue. . . . . . .
Other L’Oréal . . . . . . . . . . . .
Revlon Colorsilk . . . . . . . . . .
23
24
25
26
27
Other Revlon . . . . . . . . . . . . Vidal Sassoon . . . . . . . . . . . 13
14
15
16
17
28
29
999
OTHER (Write In)
Used For:
055-0
Cover Gray . . . . . . . . . . . . . . 1
Change/Highlight Color . . . . 2
HAIR GROWTH
PRODUCTS
You Personally:
Used in
Times/
last 6
last 7
months
days
024
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Nioxin . . . . . . . . . . . . . . . . . .
Propecia . . . . . . . . . . . . . . . .
Rogaine . . . . . . . . . . . . . . . .
Scalp Med . . . . . . . . . . . . . .
OTHER (Write In)
You Personally:
Used in
Times/
last 6
last 7
months
days
FACIAL
MOISTURIZERS
025
TOTAL: . . . . . . . . . . . . . . . . .
KINDS:
Leave-in . . . . . . . . . . . . . . . .
Rinse-out . . . . . . . . . . . . . . .
BRANDS:
Alberto VO5 Hot Oil . . . . . . .
Aussie 3 Minute Miracle . . . .
Garnier Fructis . . . . . . . . . . .
Infusium 23. . . . . . . . . . . . . .
It’s a 10 . . . . . . . . . . . . . . . . .
Pantene Pro-V . . . . . . . . . . .
TRESemmé . . . . . . . . . . . . .
Ultra Sheen . . . . . . . . . . . . .
HAIR COLORING
PRODUCTS
(For use at home)
Page 6
00
01
02
03
04
999
TOTAL:
030
................. TYPES:
Aerosol Spray . . . . . . . . . . . . Manual Pump Spray . . . . . . . Spritz . . . . . . . . . . . . . . . . . . BRANDS:
Alberto VO5 . . . . . . . . . . . . .
Aqua Net. . . . . . . . . . . . . . . .
Aussie. . . . . . . . . . . . . . . . . .
Bed Head . . . . . . . . . . . . . . .
Big Sexy Hair . . . . . . . . . . . .
Bumble and Bumble . . . . . . .
Consort. . . . . . . . . . . . . . . . .
Dove . . . . . . . . . . . . . . . . . . .
Finesse. . . . . . . . . . . . . . . . .
Garnier Fructis . . . . . . . . . . .
Göt2b . . . . . . . . . . . . . . . . . .
John Frieda . . . . . . . . . . . . .
Matrix . . . . . . . . . . . . . . . . . .
Nexxus . . . . . . . . . . . . . . . . .
Pantene Pro-V . . . . . . . . . . .
Paul Mitchell . . . . . . . . . . . . .
Rave . . . . . . . . . . . . . . . . . . .
Redken . . . . . . . . . . . . . . . . .
Sebastian . . . . . . . . . . . . . . .
Suave . . . . . . . . . . . . . . . . . . TRESemmé . . . . . . . . . . . . . White Rain . . . . . . . . . . . . . . 00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
999
OTHER (Write In)
HAIR STYLING GELS,
LOTIONS & MOUSSE
You Personally:
Used in
Times/
last 6
last 7
months
days
................. TYPES:
Mousse. . . . . . . . . . . . . . . . . Styling Gel/Lotion . . . . . . . . . Serum. . . . . . . . . . . . . . . . . . BRANDS:
Alberto VO5 . . . . . . . . . . . . .
American Crew . . . . . . . . . . .
Aussie. . . . . . . . . . . . . . . . . .
Aveda . . . . . . . . . . . . . . . . . .
Axe . . . . . . . . . . . . . . . . . . . .
Bed Head . . . . . . . . . . . . . . .
Bumble and Bumble . . . . . . .
Dep. . . . . . . . . . . . . . . . . . . .
Dove . . . . . . . . . . . . . . . . . . .
Finesse. . . . . . . . . . . . . . . . .
Garnier Fructis . . . . . . . . . . .
Göt2b . . . . . . . . . . . . . . . . . .
It’s a 10 . . . . . . . . . . . . . . . . .
John Frieda Frizz Ease. . . . .
LA Looks . . . . . . . . . . . . . . .
Matrix . . . . . . . . . . . . . . . . . .
Nexxus . . . . . . . . . . . . . . . . .
Pantene Pro-V . . . . . . . . . . .
Paul Mitchell . . . . . . . . . . . . .
Redken . . . . . . . . . . . . . . . . .
Sebastian . . . . . . . . . . . . . . .
Suave . . . . . . . . . . . . . . . . . .
TRESemmé . . . . . . . . . . . . .
White Rain . . . . . . . . . . . . . .
OTHER (Write In)
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Cream. . . . . . . . . . . . . . . . . .
Lotion . . . . . . . . . . . . . . . . . .
BRANDS:
Ambi . . . . . . . . . . . . . . . . . . .
Aveeno . . . . . . . . . . . . . . . . .
Avon . . . . . . . . . . . . . . . . . . .
Clean & Clear. . . . . . . . . . . .
Clinique . . . . . . . . . . . . . . . .
Elizabeth Arden . . . . . . . . . .
Estée Lauder . . . . . . . . . . . .
Eucerin . . . . . . . . . . . . . . . . .
Garnier . . . . . . . . . . . . . . . . .
Jergens. . . . . . . . . . . . . . . . .
Lancôme . . . . . . . . . . . . . . .
L’Oréal RevitaLift. . . . . . . . . .
L’Oréal Youth Code . . . . . . . .
Other L’Oréal . . . . . . . . . . . .
Mary Kay . . . . . . . . . . . . . . .
Neutrogena Healthy Skin . . .
Other Neutrogena . . . . . . . .
Night of Olay. . . . . . . . . . . . .
Nivea . . . . . . . . . . . . . . . . . .
Nivea Men . . . . . . . . . . . . . .
Noxzema Skin Cream. . . . . .
Olay Complete . . . . . . . . . . .
Olay ProX . . . . . . . . . . . . . . .
Olay Regenerist . . . . . . . . . .
Olay Total Effects . . . . . . . . .
Other Olay . . . . . . . . . . . . . .
Origins . . . . . . . . . . . . . . . . .
philosophy . . . . . . . . . . . . . .
Pond’s. . . . . . . . . . . . . . . . . .
RoC . . . . . . . . . . . . . . . . . . .
StriVectin-SD . . . . . . . . . . . .
St. Ives . . . . . . . . . . . . . . . . .
Vaseline . . . . . . . . . . . . . . . .
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
999
OTHER (Write In)
027
TOTAL:
You Personally:
Used in
Times/
last 6
last 7
months
days
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
How do you use it?
031-0
Anti-wrinkle. . . . . . . . . . . . . . 1
Cleansing . . . . . . . . . . . . . . . 2
Moisturizing . . . . . . . . . . . . . 3
Night Cream . . . . . . . . . . . . . 4
Sunscreen . . . . . . . . . . . . . . 5
Under make-up . . . . . . . . . . 6
MEN:
PLEASE SKIP TO 3RD COLUMN PAGE 9
WOMEN: PLEASE CONTINUE
HOME PERMANENTS
AND RELAXERS
(Women)
028
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Perm. . . . . . . . . . . . . . . . . . .
Relaxer . . . . . . . . . . . . . . . . .
BRANDS:
Africa’s Best . . . . . . . . . . . . .
African Pride . . . . . . . . . . . . .
Dark & Lovely . . . . . . . . . . . .
Gentle Treatment . . . . . . . . .
Motions. . . . . . . . . . . . . . . . .
Ogilvie . . . . . . . . . . . . . . . . .
Optimum Care . . . . . . . . . . .
Soft & Beautiful. . . . . . . . . . .
OTHER (Write In)
20
21
22
23
24
25
26
27
28
999
You Personally:
Used in
Times/
last 6
last 6
months
months
HAIR CARE
PRODUCTS
(Women)
00
01
02
03
04
05
06
07
08
09
10
999
You Personally:
Used in
last 6
months
029-0
Yes . . . . . . . . . . . . . . . . . . . . . . . .
TYPES:
Blow Dryer . . . . . . . . . . . . . . . . . .
Brushes . . . . . . . . . . . . . . . . . . . .
Diffuser . . . . . . . . . . . . . . . . . . . . .
Electric Curlers. . . . . . . . . . . . . . .
Electric Curling Iron/Brush . . . . . .
Hair Rollers. . . . . . . . . . . . . . . . . .
Straightening Iron . . . . . . . . . . . . .
1
2
3
4
5
6
7
8
Page 7
BATH/SHOWER
ADDITIVES
(Women)
You Personally:
Used in
Times/
last 6
last 7
months
days
LOOSE OR PRESSED
FACE POWDER
(Women)
032
TOTAL:
TYPES:
Bubble Bath . . . . . . . . . . . . . Bath Beads/Powder/Salts. . . In Shower Moisturizer . . . . . BRANDS:
Avon . . . . . . . . . . . . . . . . . . .
Calgon . . . . . . . . . . . . . . . . .
Mr. Bubble . . . . . . . . . . . . . .
Neutrogena Rainbath . . . . . .
Olay In-Shower Lotion . . . . .
OTHER (Write In)
00
01
02
03
04
05
06
07
08
09
999
You Personally:
Used in
Times/
last 6
last 7
months
days
033
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Cream. . . . . . . . . . . . . . . . . .
Duo Cream/Powder . . . . . . .
Liquid . . . . . . . . . . . . . . . . . .
Stick . . . . . . . . . . . . . . . . . . .
BRANDS:
Almay Smart Shade . . . . . . .
Other Almay . . . . . . . . . . . . .
Avon . . . . . . . . . . . . . . . . . . .
bareMinerals. . . . . . . . . . . . .
Bobbi Brown . . . . . . . . . . . . .
00
01
02
03
04
05
06
07
08
09
Chanel . . . . . . . . . . . . . . . . .
Clinique Superbalanced . . . .
Clinique Even Better. . . . . . .
Other Clinique . . . . . . . . . . .
CoverGirl & Olay Simply
Ageless . . . . . . . . . . . . . . .
10
11
12
13
14
CoverGirl Clean . . . . . . . . . .
CoverGirl Queen Collection. .
CoverGirl CG Smoothers . . .
CoverGirl TruBlend . . . . . . . .
Other CoverGirl . . . . . . . . . .
15
16
17
18
19
Estée Lauder . . . . . . . . . . . .
Fashion Fair . . . . . . . . . . . . .
Lancôme . . . . . . . . . . . . . . .
L’Oréal True Match . . . . . . . .
L’Oréal Visible Lift . . . . . . . . .
20
21
22
23
24
Other L’Oréal . . . . . . . . . . . .
M.A.C. . . . . . . . . . . . . . . . . .
Make Up For Ever . . . . . . . .
Mary Kay . . . . . . . . . . . . . . .
Maybelline Dream Mousse. .
25
26
27
28
29
TOTAL:
TYPES:
Loose . . . . . . . . . . . . . . . . . . Pressed . . . . . . . . . . . . . . . . BRANDS:
Almay . . . . . . . . . . . . . . . . . .
Avon . . . . . . . . . . . . . . . . . . .
Bobbi Brown . . . . . . . . . . . . .
Chanel . . . . . . . . . . . . . . . . .
Clinique . . . . . . . . . . . . . . . .
CoverGirl . . . . . . . . . . . . . . .
Estée Lauder . . . . . . . . . . . .
Lancôme . . . . . . . . . . . . . . .
L’Oréal . . . . . . . . . . . . . . . . .
M.A.C.. . . . . . . . . . . . . . . . . .
Mary Kay . . . . . . . . . . . . . . .
Maybelline . . . . . . . . . . . . . .
Merle Norman . . . . . . . . . . .
Neutrogena. . . . . . . . . . . . . .
N.Y.C. New York Color . . . . .
Physicians Formula . . . . . . . Revlon . . . . . . . . . . . . . . . . . Rimmel . . . . . . . . . . . . . . . . . 30
31
32
33
34
Physicians Formula . . . . . . .
Revlon Age Defying . . . . . . .
Revlon ColorStay . . . . . . . . .
Revlon PhotoReady . . . . . . .
Other Revlon . . . . . . . . . . . .
35
36
37
38
39
Rimmel . . . . . . . . . . . . . . . . . Smashbox . . . . . . . . . . . . . . 40
41
999
BLUSHER (Women)
00
01
02
03
04
05
06
07
08
09
10
11
12
TYPES:
Cream/Gel/Liquid . . . . . . . . . Cream/Powder . . . . . . . . . . . Cake/Powder . . . . . . . . . . . . BRANDS:
Almay . . . . . . . . . . . . . . . . . .
Avon . . . . . . . . . . . . . . . . . . .
Bobbi Brown . . . . . . . . . . . . .
Chanel . . . . . . . . . . . . . . . . .
Clinique . . . . . . . . . . . . . . . .
CoverGirl Cheekers . . . . . . .
CoverGirl Classic Color . . . .
Estée Lauder . . . . . . . . . . . .
L.A. Colors . . . . . . . . . . . . . .
Lancôme . . . . . . . . . . . . . . .
L’Oréal . . . . . . . . . . . . . . . . .
M.A.C. . . . . . . . . . . . . . . . . .
Mary Kay . . . . . . . . . . . . . . .
Maybelline Fit Me . . . . . . . . .
Maybelline Mineral Power . .
Other Maybelline . . . . . . . . .
Merle Norman . . . . . . . . . . .
NARS . . . . . . . . . . . . . . . . . .
Neutrogena. . . . . . . . . . . . . .
Revlon . . . . . . . . . . . . . . . . .
Rimmel . . . . . . . . . . . . . . . . .
Smashbox . . . . . . . . . . . . . . ................. 00
BRANDS:
Almay . . . . . . . . . . . . . . . . . .
Avon . . . . . . . . . . . . . . . . . . .
Clinique . . . . . . . . . . . . . . . .
CoverGirl . . . . . . . . . . . . . . .
Estée Lauder . . . . . . . . . . . .
01
02
03
04
05
Lancôme . . . . . . . . . . . . . . .
Mary Kay . . . . . . . . . . . . . . .
Maybelline . . . . . . . . . . . . . .
Neutrogena. . . . . . . . . . . . . .
06
07
08
09
10
Physicians Formula . . . . . . . Revlon . . . . . . . . . . . . . . . . . Rimmel . . . . . . . . . . . . . . . . . 11
12
13
999
OTHER (Write In)
14
15
16
LIPSTICK & LIP
GLOSS (Women)
17
18
19
20
999
You Personally:
Used in
Times/
last 6
last 7
months
days
................. TOTAL:
13
035
TOTAL:
You Personally:
Used in
Times/
last 6
last 7
months
days
026
................. OTHER (Write In)
Maybelline Fit Me . . . . . . . . .
Maybelline Instant Age
Rewind . . . . . . . . . . . . . . .
Merle Norman . . . . . . . . . . .
Neutrogena. . . . . . . . . . . . . .
OTHER (Write In)
BRONZER
(Women)
034
................. FOUNDATION
MAKE-UP
(Women)
You Personally:
Used in
Times/
last 6
last 7
months
days
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
999
You Personally:
Used in
Times/
last 6
last 7
months
days
037
TOTAL:
................. 00
TYPES:
Lipcolor in Compact . . . . . . .
Lipstick . . . . . . . . . . . . . . . . .
Lipstick in a Pencil . . . . . . . .
Lip Gloss . . . . . . . . . . . . . . .
Lip Liners . . . . . . . . . . . . . . .
Lip Stain . . . . . . . . . . . . . . . .
01
02
03
04
05
06
BRANDS:
Almay . . . . . . . . . . . . . . . . . .
Avon . . . . . . . . . . . . . . . . . . .
Bobbi Brown . . . . . . . . . . . . .
Bonne Bell . . . . . . . . . . . . . .
Burt’s Bees. . . . . . . . . . . . . .
07
08
09
10
11
Chanel . . . . . . . . . . . . . . . . .
Clinique . . . . . . . . . . . . . . . .
CoverGirl LipPerfection. . . . .
CoverGirl Outlast . . . . . . . . .
12
13
14
15
16
Dior. . . . . . . . . . . . . . . . . . . .
Estée Lauder . . . . . . . . . . . .
Fashion Fair . . . . . . . . . . . . .
L.A. Colors . . . . . . . . . . . . . .
17
18
19
20
21
Lancôme . . . . . . . . . . . . . . .
L’Oréal Colour Riche. . . . . . .
L’Oréal Infallible . . . . . . . . . .
Other L’Oréal . . . . . . . . . . . .
M.A.C.. . . . . . . . . . . . . . . . . .
22
23
24
25
26
Make Up For Ever . . . . . . . .
Mary Kay . . . . . . . . . . . . . . .
Maybelline Color
Sensational. . . . . . . . . . . .
Maybelline Superstay
24 Color . . . . . . . . . . . . . .
27
28
29
30
31
Merle Norman . . . . . . . . . . .
Neutrogena. . . . . . . . . . . . . .
Revlon ColorBurst . . . . . . . .
32
33
34
35
36
Revlon Super Lustrous . . . . .
Other Revlon . . . . . . . . . . . .
Rimmel . . . . . . . . . . . . . . . . .
Smashbox . . . . . . . . . . . . . .
Wet ’n Wild . . . . . . . . . . . . . .
37
38
39
40
41
999
OTHER (Write In)
OTHER (Write In)
EYE SHADOW
(Women)
You Personally:
Used in
Times/
last 6
last 7
months
days
MASCARA (Women)
038
TOTAL:
TYPES:
Crayon/Pencil . . . . . . . . . . . . Cream. . . . . . . . . . . . . . . . . . Powder . . . . . . . . . . . . . . . . . BRANDS:
Almay . . . . . . . . . . . . . . . . . .
Avon . . . . . . . . . . . . . . . . . . .
bareMinerals. . . . . . . . . . . . .
Bobbi Brown . . . . . . . . . . . . .
Chanel . . . . . . . . . . . . . . . . .
Clinique . . . . . . . . . . . . . . . .
CoverGirl Eye Enhancers . . .
e.l.f. . . . . . . . . . . . . . . . . . . .
Estée Lauder . . . . . . . . . . . .
L.A. Colors . . . . . . . . . . . . . .
Lancôme . . . . . . . . . . . . . . .
L’Oréal . . . . . . . . . . . . . . . . .
M.A.C. . . . . . . . . . . . . . . . . .
Mary Kay . . . . . . . . . . . . . . .
Maybelline ExpertWear . . . .
Maybelline Eye Studio . . . . .
Milani . . . . . . . . . . . . . . . . . .
Other Revlon . . . . . . . . . . . .
Rimmel . . . . . . . . . . . . . . . . .
Wet ’n Wild . . . . . . . . . . . . . .
OTHER (Write In)
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
26
27
28
999
TYPES:
Cake . . . . . . . . . . . . . . . . . . .
Liquid . . . . . . . . . . . . . . . . . .
Pen (Felt Tip) . . . . . . . . . . . .
Pencil . . . . . . . . . . . . . . . . . .
BRANDS:
Almay . . . . . . . . . . . . . . . . . .
Avon . . . . . . . . . . . . . . . . . . .
Bobbi Brown . . . . . . . . . . . . .
Chanel . . . . . . . . . . . . . . . . .
Clinique . . . . . . . . . . . . . . . .
CoverGirl Perfect Point Plus. .
e.l.f. . . . . . . . . . . . . . . . . . . .
Estée Lauder . . . . . . . . . . . .
Lancôme . . . . . . . . . . . . . . .
L’Oréal . . . . . . . . . . . . . . . . .
M.A.C. . . . . . . . . . . . . . . . . .
Mary Kay . . . . . . . . . . . . . . .
Maybelline Define-a-Line . . .
Maybelline Eye Studio Gel . .
Maybelline Ultra Liner. . . . . .
Maybelline Unstoppable . . . .
Milani . . . . . . . . . . . . . . . . . .
Neutrogena. . . . . . . . . . . . . .
Other Revlon . . . . . . . . . . . .
Rimmel . . . . . . . . . . . . . . . . .
Wet ’n Wild . . . . . . . . . . . . . .
OTHER (Write In)
NAIL CARE
PRODUCTS & POLISH
(Women)
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
999
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
999
You Personally:
Used in
Times/
last 6
last 7
months
days
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Basecoat . . . . . . . . . . . . . . .
Cuticle Care . . . . . . . . . . . . .
Polish (Nail Color). . . . . . . . .
Strengthener/Hardener. . . . .
Topcoat. . . . . . . . . . . . . . . . .
FORMS:
Fast Drying . . . . . . . . . . . . . .
Regular Drying . . . . . . . . . . .
Gel . . . . . . . . . . . . . . . . . . . .
BRANDS:
Avon . . . . . . . . . . . . . . . . . . .
Chanel . . . . . . . . . . . . . . . . .
CoverGirl . . . . . . . . . . . . . . .
Essie. . . . . . . . . . . . . . . . . . .
Estée Lauder . . . . . . . . . . . .
L.A. Colors . . . . . . . . . . . . . .
Lancôme . . . . . . . . . . . . . . .
L’Oréal . . . . . . . . . . . . . . . . .
Maybelline . . . . . . . . . . . . . .
Nicole by OPI . . . . . . . . . . . .
OPI . . . . . . . . . . . . . . . . . . . .
Pure Ice . . . . . . . . . . . . . . . .
Revlon . . . . . . . . . . . . . . . . .
Rimmel . . . . . . . . . . . . . . . . .
Sally Hansen Nail Care . . . .
Sally Hansen Complete
Salon Polish . . . . . . . . . . .
Sally Hansen Diamond
Strength Polish . . . . . . . . .
Sally Hansen Insta-Dri . . . . .
Sally Hansen Miracle Gel . . .
Sally Hansen Salon Effects
Nail Polish Strips. . . . . . . .
Sally Hansen Xtreme Wear .
Other Sally Hansen Polish . .
SinfulColors . . . . . . . . . . . . .
Wet ’n Wild . . . . . . . . . . . . . .
Zoya . . . . . . . . . . . . . . . . . . .
OTHER (Write In)
You Personally:
Used in
Times/
last 6
last 7
months
days
BRANDS:
Cutex (instant) . . . . . . . . . . .
Cutex (liquid) . . . . . . . . . . . .
Pretty Nails (instant) . . . . . . .
Sally Hansen Kwik Off
(instant). . . . . . . . . . . . . . .
Sally Hansen (liquid) . . . . . .
00
01
02
03
Store’s Own Brand . . . . . . . . 04
05
06
999
OTHER (Write In)
FEMININE HYGIENE
DEODORANT/
CLEANSING
PRODUCTS (Women)
You Personally:
Used in
Times/
last 6
last 7
months
days
043
TOTAL:
................. BRANDS:
Always Wipes . . . . . . . . . . . .
FDS . . . . . . . . . . . . . . . . . . .
Monistat Stay Fresh . . . . . . .
Norforms . . . . . . . . . . . . . . .
Playtex Cleansing Cloths . . .
Summer’s Eve Cleansing
Wash . . . . . . . . . . . . . . . .
Other Summer’s Eve . . . . . .
Vagisil Deodorant Powder . .
Vagisil Wash . . . . . . . . . . . . .
Other Vagisil . . . . . . . . . . . . .
00
01
02
03
04
05
06
07
08
09
10
999
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
999
You Personally:
Used in
Times/
last 6
last 30
months
days
044
00
01
02
03
04
05
................. FEMININE HYGIENE
DOUCHES
(Women)
TOTAL:
OTHER (Write In)
041
You Personally:
Used in
Times/
last 6
last 7
months
days
................. OTHER (Write In)
NAIL POLISH
REMOVER (Women)
042
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Regular. . . . . . . . . . . . . . . . .
Water Proof/Resistant. . . . . .
FORMS:
Curling . . . . . . . . . . . . . . . . .
Volume/Thickening . . . . . . . .
BRANDS:
Almay . . . . . . . . . . . . . . . . . .
Avon . . . . . . . . . . . . . . . . . . .
Clinique . . . . . . . . . . . . . . . .
CoverGirl Clump Crusher . . .
CoverGirl LashBlast . . . . . . .
CoverGirl Professional . . . . .
Dior. . . . . . . . . . . . . . . . . . . .
e.l.f.. . . . . . . . . . . . . . . . . . . .
Estée Lauder . . . . . . . . . . . .
Lancôme . . . . . . . . . . . . . . .
L’Oréal Double Extend . . . . .
L’Oréal Voluminous . . . . . . . .
Other L’Oréal . . . . . . . . . . . .
M.A.C. . . . . . . . . . . . . . . . . .
Mary Kay . . . . . . . . . . . . . . .
Maybelline the Colossal . . . .
Maybelline Great Lash . . . . .
Maybelline the Falsies . . . . .
Maybelline Volum’ Express . .
Neutrogena. . . . . . . . . . . . . .
Revlon . . . . . . . . . . . . . . . . .
Rimmel . . . . . . . . . . . . . . . . .
25
039
TOTAL:
You Personally:
Used in
Times/
last 6
last 7
months
days
040
................. EYE LINER
(Women)
Page 8
TOTAL:
................. BRANDS:
Massengill . . . . . . . . . . . . . . Summer’s Eve Vinegar &
Water . . . . . . . . . . . . . . . . Other Summer’s Eve . . . . . . 00
01
02
03
999
OTHER (Write In)
TAMPONS (Women)
You Personally:
Used in
Number
last 6
in last
months
30 days
045
TOTAL:
................. TYPES:
Slender. . . . . . . . . . . . . . . . .
Regular. . . . . . . . . . . . . . . . .
Super . . . . . . . . . . . . . . . . . .
Super-Plus . . . . . . . . . . . . . .
BRANDS:
U by Kotex. . . . . . . . . . . . . . .
o.b. . . . . . . . . . . . . . . . . . . . .
Playtex Gentle Glide. . . . . . .
Playtex Sport . . . . . . . . . . . .
Tampax Cardboard
Applicator . . . . . . . . . . . . .
Tampax Pearl (Plastic
Applicator). . . . . . . . . . . . .
Tampax Pearl Active . . . . . . .
Tampax Pocket Pearl . . . . . .
Tampax Radiant . . . . . . . . . .
OTHER (Write In)
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
999
Page 9
SANITARY NAPKINS
(Women)
You Personally:
Used in
Number/
last 6
last 30
months
days
PERFUME AND
COLOGNE
FOR WOMEN
................. 00
TYPES:
Scented . . . . . . . . . . . . . . . . Unscented . . . . . . . . . . . . . . 01
02
KINDS:
Regular (non-winged). . . . . . With Wings . . . . . . . . . . . . . . BRANDS:
Always Infinity. . . . . . . . . . . .
Always Radiant Infinity . . . . .
Always Overnight Maxi . . . . .
Always Regular Maxi . . . . . .
Always Ultra Thin . . . . . . . . .
Other Always . . . . . . . . . . . .
Playtex Sport . . . . . . . . . . . .
Stayfree Maxi Regular . . . . .
Stayfree Maxi Super . . . . . .
Stayfree Ultra Thin . . . . . . . .
Other Stayfree . . . . . . . . . . .
U by Kotex Maxi . . . . . . . . . .
U by Kotex Overnight Pads .
U by Kotex Ultra Thin . . . . . .
Other U by Kotex . . . . . . . . .
Store’s Own Brand . . . . . . . . 03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
999
OTHER (Write In)
PANTILINERS
(Women)
You Personally:
Used in
Number/
last 6
last 30
months
days
048
................. 00
TYPES:
Scented . . . . . . . . . . . . . . . . Unscented . . . . . . . . . . . . . . Odor Absorbing . . . . . . . . . . 01
02
03
KINDS:
Regular. . . . . . . . . . . . . . . . . Long/Extra Coverage . . . . . . Thong . . . . . . . . . . . . . . . . . . 04
05
06
BRANDS:
Always Incredibly Thin . . . . .
Always Radiant . . . . . . . . . .
Always Xtra Protection . . . . .
Other Always . . . . . . . . . . . .
Carefree Original . . . . . . . . .
07
08
09
10
11
12
13
14
15
16
Other U by Kotex . . . . . . . . . Store’s Own Brand . . . . . . . . 17
18
999
TOTAL:
Carefree Acti-Fresh. . . . . . . .
Other Carefree . . . . . . . . . . .
Tampax Pearl . . . . . . . . . . . .
U by Kotex Lightdays
Regular . . . . . . . . . . . . . . .
U by Kotex Lightdays Long. .
OTHER (Write In)
IN-HOME
PREGNANCY TEST/
OVULATION TEST
(Women)
You Personally:
Used in
Times/
last 12
last 12
months
months
047
TOTAL: . . . . . . . . . . . . . . . . . TYPES:
Pregnancy Test . . . . . . . . . . . Ovulation Test/Predictor . . . . BRANDS:
Clearblue . . . . . . . . . . . . . . .
e.p.t. . . . . . . . . . . . . . . . . . . .
First Response . . . . . . . . . . .
OTHER (Write In)
AFTERSHAVE LOTION
& COLOGNE
FOR MEN
049
046
TOTAL:
You Personally:
Used in
Times/
last 6
last 7
months
days
00
01
02
03
04
05
06
999
050
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Cologne . . . . . . . . . . . . . . . .
Perfume . . . . . . . . . . . . . . . .
After Bath Splash . . . . . . . . .
Body Spray. . . . . . . . . . . . . .
BRANDS:
Acqua di Gioia . . . . . . . . . . .
Angel . . . . . . . . . . . . . . . . . .
Avon . . . . . . . . . . . . . . . . . . .
Beautiful . . . . . . . . . . . . . . . .
Beyoncé . . . . . . . . . . . . . . . .
Body Fantasies. . . . . . . . . . .
Britney Spears . . . . . . . . . . .
Burberry Body . . . . . . . . . . .
Cashmere Mist . . . . . . . . . . .
Celine Dion. . . . . . . . . . . . . .
Chance . . . . . . . . . . . . . . . .
Chanel No. 5. . . . . . . . . . . . .
Other Chanel . . . . . . . . . . . .
Charlie . . . . . . . . . . . . . . . . .
Chloé . . . . . . . . . . . . . . . . . .
ck One . . . . . . . . . . . . . . . . .
Clinique Happy . . . . . . . . . . .
Coco . . . . . . . . . . . . . . . . . . .
Coco Mademoiselle . . . . . . .
20
21
22
23
24
Curve . . . . . . . . . . . . . . . . . .
DKNY . . . . . . . . . . . . . . . . . .
Dolce & Gabbana. . . . . . . . .
Escada . . . . . . . . . . . . . . . . .
Eternity. . . . . . . . . . . . . . . . .
25
26
27
28
29
Euphoria. . . . . . . . . . . . . . . .
Flowerbomb . . . . . . . . . . . . .
Gucci . . . . . . . . . . . . . . . . . .
Guess. . . . . . . . . . . . . . . . . .
Halle . . . . . . . . . . . . . . . . . . .
30
31
32
33
34
Issey Miyake. . . . . . . . . . . . .
J’adore . . . . . . . . . . . . . . . . .
Jennifer Lopez . . . . . . . . . . .
Jimmy Choo . . . . . . . . . . . . .
Jovan . . . . . . . . . . . . . . . . . .
Juicy Couture . . . . . . . . . . . .
La Vie Est Belle . . . . . . . . . .
Lady Gaga . . . . . . . . . . . . . .
Marc Jacobs . . . . . . . . . . . . .
Mary Kay . . . . . . . . . . . . . . .
Michael Kors. . . . . . . . . . . . .
Miss Dior . . . . . . . . . . . . . . .
Modern Muse . . . . . . . . . . . .
Narciso Rodriguez . . . . . . . .
Obsession . . . . . . . . . . . . . .
Opium. . . . . . . . . . . . . . . . . .
Oscar de la Renta . . . . . . . .
Passion. . . . . . . . . . . . . . . . .
Pleasures . . . . . . . . . . . . . . .
Poison . . . . . . . . . . . . . . . . .
50
51
52
53
54
Prada . . . . . . . . . . . . . . . . . .
Ralph . . . . . . . . . . . . . . . . . .
Red Door . . . . . . . . . . . . . . .
Romance . . . . . . . . . . . . . . .
Sarah Jessica Parker . . . . . .
55
56
57
58
59
Secret Body Spray . . . . . . . .
Shalimar . . . . . . . . . . . . . . . .
Sì . . . . . . . . . . . . . . . . . . . . .
Tory Burch . . . . . . . . . . . . . .
Trésor . . . . . . . . . . . . . . . . . .
60
61
62
63
64
Vera Wang . . . . . . . . . . . . . .
Victoria’s Secret . . . . . . . . . .
White Diamonds . . . . . . . . . .
White Linen. . . . . . . . . . . . . .
Wind Song . . . . . . . . . . . . . .
OTHER (Write In)
You Personally:
Used in
Times/
last 6
last 7
months
days
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
65
66
67
68
69
999
................. 00
TYPES:
After Shave . . . . . . . . . . . . . . Cologne . . . . . . . . . . . . . . . . 01
02
TOTAL:
BRANDS:
1 Million . . . . . . . . . . . . . . . .
Acqua di Gio . . . . . . . . . . . . .
Adidas. . . . . . . . . . . . . . . . . .
Afta . . . . . . . . . . . . . . . . . . . .
Aqua Velva . . . . . . . . . . . . . .
Armani Code . . . . . . . . . . . .
Avon . . . . . . . . . . . . . . . . . . .
Bleu de Chanel. . . . . . . . . . .
Brut. . . . . . . . . . . . . . . . . . . .
Burberry . . . . . . . . . . . . . . . .
Chanel . . . . . . . . . . . . . . . . .
Chrome. . . . . . . . . . . . . . . . .
ck One . . . . . . . . . . . . . . . . .
Cool Water . . . . . . . . . . . . . .
Curve . . . . . . . . . . . . . . . . . .
Dior Homme . . . . . . . . . . . . .
Dolce & Gabbana. . . . . . . . .
Drakkar Noir . . . . . . . . . . . . .
Ed Hardy . . . . . . . . . . . . . . .
English Leather . . . . . . . . . .
Ermenegildo Zegna . . . . . . .
Eternity . . . . . . . . . . . . . . . . .
euphoria men . . . . . . . . . . . .
Gillette . . . . . . . . . . . . . . . . .
Gucci . . . . . . . . . . . . . . . . . .
Hugo Boss . . . . . . . . . . . . . .
Invictus . . . . . . . . . . . . . . . . .
Issey Miyake. . . . . . . . . . . . .
Jean Paul Gaultier Le Male .
Kenneth Cole . . . . . . . . . . . .
L’Homme Yves Saint Laurent .
Michael Kors. . . . . . . . . . . . .
Montblanc Legend . . . . . . . .
Nautica . . . . . . . . . . . . . . . . .
Nivea Men . . . . . . . . . . . . . .
Obsession For Men . . . . . . .
Old Spice . . . . . . . . . . . . . . .
Playboy. . . . . . . . . . . . . . . . .
Polo Black . . . . . . . . . . . . . .
Polo Blue . . . . . . . . . . . . . . .
Polo Red . . . . . . . . . . . . . . .
Other Polo . . . . . . . . . . . . . .
Prada . . . . . . . . . . . . . . . . . .
Sean John . . . . . . . . . . . . . .
Skin Bracer. . . . . . . . . . . . . .
Stetson . . . . . . . . . . . . . . . . .
Usher VIP . . . . . . . . . . . . . . .
Versace. . . . . . . . . . . . . . . . .
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
999
OTHER (Write In)
TOTAL PERFUME
AND COLOGNE
EXPENDITURES
As a gift:
$ 1-$49 . . . . . . . . . . .
$ 50-$99 . . . . . . . . . . .
$100-$249 . . . . . . . . . .
$250 or more . . . . . . . .
For yourself:
Amount you personally
spent on perfume
& cologne,
last 12 months:
For Men
For Women
051-0
1
2
3
4
052-0
1
2
3
4
For Men
For Women
$ 1-$49 . . . . . . . . . . .
5
$ 50-$99 . . . . . . . . . . .
6
$100-$249 . . . . . . . . . .
7
$250 or more . . . . . . . .
8
Write in number bought,
last 12 months:
For Men
14K
5
6
7
8
For Women
14L
As a gift . . . . . . . . . . . .
01
01
For yourself . . . . . . . . .
02
02
DISPOSABLE
RAZORS
You Personally:
Used in
Times/
last 6
last 7
months
days
SHAVING CREAMS
OR GELS
BRANDS:
Bic Classic Lady. . . . . . . . . .
Bic Comfort 3 Advance. . . . .
Bic Comfort Twin . . . . . . . . .
Bic Flex 4 . . . . . . . . . . . . . . .
Bic Soleil . . . . . . . . . . . . . . .
Bic Twin Select . . . . . . . . . .
Other Bic . . . . . . . . . . . . . . .
Gillette Custom Plus . . . . . . .
Gillette Fusion. . . . . . . . . . . .
Gillette Good News! Plus . . .
Gillette Mach 3 . . . . . . . . . . .
Gillette Sensor 3. . . . . . . . . .
Gillette Venus Disposables . .
Noxzema . . . . . . . . . . . . . . .
Schick Quattro for Women . .
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
Schick Xtreme 3 . . . . . . . . . . Other Schick. . . . . . . . . . . . . 16
17
999
OTHER (Write In)
You Personally:
Used in
Times/
last 6
last 7
months
days
054
TOTAL: . . . . . . . . . . . . . . . . . . BRANDS:
Gillette Fusion. . . . . . . . . . . .
Gillette Fusion Power . . . . . .
Gillette Fusion ProGlide . . . .
Gillette Mach3 . . . . . . . . . . .
Gillette Mach3 Turbo. . . . . . .
00
Gillette Sensor . . . . . . . . . . .
Gillette Sensor Excel . . . . . .
Gillette Venus . . . . . . . . . . . .
Gillette Venus Breeze . . . . . .
Gillette Venus Embrace . . . .
Gillette Venus & Olay . . . . . .
Harry’s . . . . . . . . . . . . . . . . .
Schick Hydro . . . . . . . . . . . .
Schick Intuition . . . . . . . . . . .
Schick Quattro . . . . . . . . . . .
01
02
03
04
05
06
08
09
10
13
14
15
16
999
You Personally:
Used in
Times/
last 6
last 7
months
days
057
................. BRANDS:
Alberto VO5 . . . . . . . . . . . . .
Brylcreem . . . . . . . . . . . . . . .
Groom & Clean. . . . . . . . . . .
Ultra Sheen . . . . . . . . . . . . .
OTHER (Write In)
HEALTH &
BEAUTY AIDS
EXPENDITURES
01
02
03
04
999
In the past 12 months,
amount spent
on the purchase of
Health & Beauty Aids:
for Men
Less than $100 . . . . .
$100-299 . . . . . . . . . .
$300-499 . . . . . . . . . .
$500 or more. . . . . . .
00
058
KINDS:
Cream. . . . . . . . . . . . . . . . . .
Foam . . . . . . . . . . . . . . . . . .
Gel . . . . . . . . . . . . . . . . . . . .
Lotion . . . . . . . . . . . . . . . . . .
Soap. . . . . . . . . . . . . . . . . . .
Other Edge. . . . . . . . . . . . . .
eos Shave Cream. . . . . . . . .
Gillette Foamy Cream. . . . . .
Gillette Foamy Sensitive . . . .
Gillette Fusion Hydra Gel . . .
Gillette Satin Care . . . . . . . .
Gillette Series . . . . . . . . . . . .
Other Gillette . . . . . . . . . . . .
Neutrogena Men. . . . . . . . . .
Nivea Men . . . . . . . . . . . . . .
Noxzema . . . . . . . . . . . . . . .
Pure Silk . . . . . . . . . . . . . . . .
Schick Hydro . . . . . . . . . . . .
Skintimate Shave Cream . . .
Skintimate Shave Gel. . . . . .
1
2
01
02
03
04
03
04
Body treatments . . . . . . . . . .
Manicure. . . . . . . . . . . . . . . .
Pedicure . . . . . . . . . . . . . . . .
Waxing . . . . . . . . . . . . . . . . .
Laser Hair Removal . . . . . . .
Other hair removal . . . . . . . .
Tanning. . . . . . . . . . . . . . . . .
Make-up application/
makeover . . . . . . . . . . . . .
Other services . . . . . . . . . . .
00
BRANDS:
Braun . . . . . . . . . . . . . . . . . .
Panasonic. . . . . . . . . . . . . . .
Philips Norelco . . . . . . . . . . .
Remington . . . . . . . . . . . . . .
02
OTHER (Write In)
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
PERSONAL FOOT
CARE PRODUCTS
27
28
29
999
01
02
03
04
05
06
07
08
09
10
13
14
00
02
BRANDS:
Band-Aid . . . . . . . . . . . . . . .
Burt’s Bees Foot Care . . . . .
Curél Foot Therapy. . . . . . . .
Dr. Scholl’s . . . . . . . . . . . . . .
Gold Bond Foot . . . . . . . . . .
Heel-Tastic . . . . . . . . . . . . . .
Johnson’s Foot Soap . . . . . .
Odor-Eaters . . . . . . . . . . . . .
O’Keeffe’s for Healthy Feet . .
OTHER (Write In)
DENTURE
ADHESIVES &
FIXATIVES
03
04
05
06
07
08
09
10
11
12
13
999
060
TOTAL: . . . . . . . . . . . . . . . . . . 00
TYPES:
Liners/Cushions/Wafers . . . .
Paste/Cream. . . . . . . . . . . . .
Powder . . . . . . . . . . . . . . . . .
Strips . . . . . . . . . . . . . . . . . .
02
BRANDS:
Fixodent Complete . . . . . . . .
Fixodent Fresh . . . . . . . . . . .
Fixodent (Regular) . . . . . . . .
Other Fixodent . . . . . . . . . . .
Super PoliGrip Original. . . . .
Super PoliGrip Free . . . . . . .
Super PoliGrip Ultra Fresh . .
Other PoliGrip. . . . . . . . . . . .
Sea-Bond . . . . . . . . . . . . . .
OTHER (Write In)
DENTURE
CLEANERS
01
03
04
05
06
07
08
09
10
11
12
13
999
You Personally:
Used in
Times/
last 6
last 7
months
days
061
TYPES:
Paste . . . . . . . . . . . . . . . . . . Powder . . . . . . . . . . . . . . . . . Tablet . . . . . . . . . . . . . . . . . . 14T-0
01
You Personally:
Used in
Times/
last 6
last 7
months
days
Yes
Visited a dayspa. . . . . . . . . . . . . . . . . . . . . . . 1
Purchased products at a salon or dayspa . . . 2
Do you wear dentures?
Yes
1
04
999
TYPES:
Cream/Gel . . . . . . . . . . . . . .
Powder . . . . . . . . . . . . . . . . .
Spray . . . . . . . . . . . . . . . . . .
Insole . . . . . . . . . . . . . . . . . .
TOTAL: . . . . . . . . . . . . . . . . . . DENTURES
03
You Personally:
Used in
Times/
last 6
last 30
months
days
In the last 6 months have you:
15P-0
01
14J
11
12
TOTAL: . . . . . . . . . . . . . . . . . . 26
15M
SERVICES:
Hair cut. . . . . . . . . . . . . . . . .
Hair color/highlights . . . . . . .
Perm/body wave. . . . . . . . . .
Facial . . . . . . . . . . . . . . . . . .
Massage. . . . . . . . . . . . . . . .
TOTAL: . . . . . . . . . . . . . . . . . . 05
You Personally:
Had
service,
Times/
last 6
last 3
months
months
for
Women
01
02
OTHER (Write In)
00
BRANDS:
Aveeno Shave Gel . . . . . . . .
Barbasol . . . . . . . . . . . . . . . .
Edge Extra Moisturizing . . . .
Edge Extra Protection. . . . . .
Edge Sensitive Skin . . . . . . .
PERSONAL
CARE
SERVICES
You Personally:
Used in
Times/
last 6
last 7
months
days
059
TYPES:
Aerosol . . . . . . . . . . . . . . . . .
Tube . . . . . . . . . . . . . . . . . . .
Mug . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . .
11
12
OTHER (Write In)
TOTAL:
ELECTRIC SHAVERS
TOTAL: . . . . . . . . . . . . . . . . . . 07
Other Schick . . . . . . . . . . . . HAIR TONIC OR
DRESSING
(Men)
You Personally:
Used in
Times/
last 6
last 7
months
days
056
053
TOTAL: . . . . . . . . . . . . . . . . . . RAZOR BLADES
Page 10
BRANDS:
Dentu-Creme . . . . . . . . . . . .
Efferdent . . . . . . . . . . . . . . . .
Fixodent . . . . . . . . . . . . . . . .
Polident . . . . . . . . . . . . . . . .
OTHER (Write In)
00
01
02
03
04
05
06
07
08
999
HEALTH AIDS
Page 11
SORE THROAT
REMEDIES &
COUGH DROPS
You Personally:
Used in
Times/
last 6
last 30
months
days
NASAL SPRAYS
064
BRANDS:
Burt’s Bees. . . . . . . . . . . . . .
Cepacol Sore Throat
Lozenges . . . . . . . . . . . . .
Cepastat Lozenges . . . . . . .
Chloraseptic Lozenges. . . . .
Chloraseptic Spray . . . . . . . .
00
01
02
03
04
05
06
07
08
09
Delsym Lozenges. . . . . . . . .
Equate . . . . . . . . . . . . . . . . .
Flanax . . . . . . . . . . . . . . . . .
Fisherman’s Friend . . . . . . . .
Halls Breezers . . . . . . . . . . .
10
11
12
13
14
Halls Defense Vitamin C. . . .
Halls Naturals . . . . . . . . . . .
Halls Plus . . . . . . . . . . . . . . .
Halls Refresh . . . . . . . . . . . .
Halls (Regular) . . . . . . . . . . .
Other Halls . . . . . . . . . . . . . .
15
16
17
18
19
20
Luden’s . . . . . . . . . . . . . . . .
N’ice Lozenges. . . . . . . . . . .
Pine Bros . . . . . . . . . . . . . . .
Ricola . . . . . . . . . . . . . . . . . .
21
22
23
24
Smith Brothers . . . . . . . . . . . Sucrets Lozenges. . . . . . . . . Store’s Own Brand . . . . . . . . 25
26
27
999
OTHER (Write In)
Used for:
065-0
Coughs . . . . . . . . . . . . . . . . . 1
Sore Throat. . . . . . . . . . . . . . 2
Other Throat Irritation . . . . . . 3
You Personally:
Used in
Times/
last 6
last 30
months
days
066
TOTAL: . . . . . . . . . . . . . . . . . . 00
BRANDS:
DayQuil Cough . . . . . . . . . . .
Delsym . . . . . . . . . . . . . . . . .
Mucinex DM . . . . . . . . . . . . .
NyQuil Cough . . . . . . . . . . . .
Robitussin CF. . . . . . . . . . . .
01
02
03
04
05
Robitussin DM . . . . . . . . . . .
Other Robitussin. . . . . . . . . .
Tukol . . . . . . . . . . . . . . . . . . .
Tylenol Cough. . . . . . . . . . . .
OTHER (Write In)
WART REMOVERS
06
07
08
09
10
999
You Personally:
Used in
Times/
last 6
last 30
months
days
TOTAL: . . . . . . . . . . . . . . . . . .
BRANDS:
Compound W . . . . . . . . . . . .
Dr. Scholl’s Clear Away. . . . .
Dr. Scholl’s Freeze Away . . .
Wartner. . . . . . . . . . . . . . . . .
00
TYPES:
Long lasting . . . . . . . . . . . . . Regular. . . . . . . . . . . . . . . . . 02
BRANDS:
Afrin . . . . . . . . . . . . . . . . . . .
Ayr . . . . . . . . . . . . . . . . . . . .
Mucinex . . . . . . . . . . . . . . . .
NeilMed . . . . . . . . . . . . . . . .
Neo-Synephrine . . . . . . . . . .
Nozin . . . . . . . . . . . . . . . . . .
Ocean. . . . . . . . . . . . . . . . . .
Simply Saline . . . . . . . . . . . .
Vicks Sinex . . . . . . . . . . . . . .
Zicam . . . . . . . . . . . . . . . . . .
Store’s Own Brand . . . . . . . . 00
01
02
03
04
999
01
03
04
05
06
07
08
09
10
11
12
13
OTHER (Write In)
You Personally:
Used in
Times/
last 6
last 30
months
days
TOTAL: . . . . . . . . . . . . . . . . . .
TYPES:
Drops . . . . . . . . . . . . . . . . . .
Wash . . . . . . . . . . . . . . . . . .
KINDS:
Antihistamine . . . . . . . . . . . .
Dry Eye Protection . . . . . . . .
Regular. . . . . . . . . . . . . . . . .
BRANDS:
Bausch + Lomb Alaway . . . .
Bausch + Lomb Dry Eye . . .
Bausch + Lomb Eye Wash . .
Bausch + Lomb Opcon-A . . .
Bausch + Lomb Soothe . . . .
Clear Eyes . . . . . . . . . . . . . .
GenTeal . . . . . . . . . . . . . . . .
Murine . . . . . . . . . . . . . . . . .
Opti-Free . . . . . . . . . . . . . . .
Optical 20/20 . . . . . . . . . . . .
Refresh Plus. . . . . . . . . . . . .
Refresh Tears . . . . . . . . . . . .
Rohto . . . . . . . . . . . . . . . . . .
Similasan . . . . . . . . . . . . . . .
Systane . . . . . . . . . . . . . . . .
Tears Naturale . . . . . . . . . . .
TheraTears . . . . . . . . . . . . . .
Visine-A . . . . . . . . . . . . . . . .
Visine A.C. . . . . . . . . . . . . . .
Visine Advanced Relief. . . . .
Visine Original . . . . . . . . . . .
Visine Tears . . . . . . . . . . . . .
Visine Tired Eye . . . . . . . . . .
Other Visine . . . . . . . . . . . . .
00
01
02
03
04
05
Used for:
070-0
Redness Removal . . . . . . . . 1
Lubrication . . . . . . . . . . . . . . 2
Allergy. . . . . . . . . . . . . . . . . . 3
LASIK
EYE SURGERY
14M-0
Have you had LASIK eye surgery to correct
vision in the last 12 months (not cataract
surgery)?
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
999
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
999
You Personally:
EYEGLASSES,
CONTACT LENSES &
SUNGLASSES
069
Yes 1
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Band-Aid Advanced Healing
Band-Aid Antibiotic . . . . . . . .
Band-Aid Clear. . . . . . . . . . .
Band-Aid Extra Large . . . . . .
Band-Aid Flexible Fabric . . .
Band-Aid Plastic. . . . . . . . . .
Band-Aid Sheer . . . . . . . . . .
Band-Aid Tough-Strips . . . . .
Other Band-Aid Bandages . .
Curad Flex-Fabric . . . . . . . . .
Curad Plastic . . . . . . . . . . . .
Curad Sheer. . . . . . . . . . . . .
Other Curad . . . . . . . . . . . . .
Nexcare Active . . . . . . . . . . .
Other Nexcare Bandages . . .
999
OTHER (Write In)
EYE WASH AND
DROPS
You Personally:
Used in
Times/
last 6
last 30
months
days
090
TOTAL: . . . . . . . . . . . . . . . . . . OTHER (Write In)
074
OTHER (Write In)
ADHESIVE
BANDAGES
068
TOTAL: . . . . . . . . . . . . . . . . . .
TYPES:
Drops/Lozenges . . . . . . . . . .
Liquid . . . . . . . . . . . . . . . . . .
Spray . . . . . . . . . . . . . . . . . .
Strips . . . . . . . . . . . . . . . . . .
COUGH SYRUP/
SUPPRESSANT
(Nonprescription)
You Personally:
Used in
Times/
last 6
last 30
months
days
Wear
091-0
Prescription Eyeglasses (sun,
tinted, regular). . . . . . . . . . . . . . .
Eyeglasses (Nonprescription) . . . .
Bi-focals . . . . . . . . . . . . . . . . . . . . .
Contact Lenses (RGP/hard) . . . . . .
Contact Lenses (soft) . . . . . . . . . . .
1
2
3
4
5
Contact Lenses (tinted/colored) . . . 6
Disposable Contact Lenses . . . . . . 7
Sunglasses (Nonprescription) . . . . 8
Transition Lenses . . . . . . . . . . . . . . 9
Where did you purchase prescription eyewear?
Discount Store Optical Center . . . .
Private Ophthalmologist, Optician
or Optometrist. . . . . . . . . . . . . . .
Retail Optical Chain . . . . . . . . . . . .
Internet/online . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . .
103-0
1
2
3
4
5
Contact Lens Brands, used last 12 months:
Acuvue . . . . . . . . . . . . . . . . . . . . . .
Air Optix . . . . . . . . . . . . . . . . . . . . .
Bausch + Lomb . . . . . . . . . . . . . . .
Biofinity. . . . . . . . . . . . . . . . . . . . . .
Dailies. . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . .
15X-0
1
2
3
4
5
6
Amount Spent 092
Last 12 Months
Eyeglasses . . . . . . . . . . . . . . $
Sunglasses (nonprescription) $
Contact Lenses . . . . . . . . . . $
CONTACT LENS
CLEANING/WETTING
SOLUTIONS
01
02
03
You Personally:
Used in
Times/
last 6
last 30
months
days
093
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Disinfecting Solution. . . . . . .
Lens Cleaning Solution . . . .
Lubricating/Rewetting
Solutions. . . . . . . . . . . . . .
Multipurpose Solutions. . . . .
Saline Solution . . . . . . . . . . .
BRANDS:
Bausch + Lomb Biotrue . . . .
Bausch + Lomb Renu. . . . . .
Other Bausch + Lomb . . . . .
Clear Care . . . . . . . . . . . . . .
Complete . . . . . . . . . . . . . . .
Opti-Free Express . . . . . . . .
Opti-Free RepleniSH . . . . . .
OTHER (Write In)
00
01
02
03
04
05
06
07
08
09
10
11
12
13
999
HEALTH AIDS
HEADACHE REMEDIES
AND PAIN RELIEVERS
(Nonprescription)
Page 12
You Personally:
Used in
Times/
last 6
last 30
months
days
COLD, SINUS AND
ALLERGY REMEDIES
(Nonprescription)
075
00
TYPES:
Aspirin Formula . . . . . . . . . . Non-Aspirin Formula . . . . . . 01
KINDS:
Caplets . . . . . . . . . . . . . . . . .
Capsules . . . . . . . . . . . . . . .
Gelcaps . . . . . . . . . . . . . . . .
Liquid . . . . . . . . . . . . . . . . . .
Liquid-Gels . . . . . . . . . . . . . .
Powder . . . . . . . . . . . . . . . . . Chewable Tablets . . . . . . . . . Other Tablets . . . . . . . . . . . . BRANDS:
Advil . . . . . . . . . . . . . . . . . . .
Advil Film-Coated . . . . . . . . .
Advil Migraine . . . . . . . . . . . .
Advil PM . . . . . . . . . . . . . . . .
Aleve. . . . . . . . . . . . . . . . . . .
Alka-Seltzer . . . . . . . . . . . . .
Anacin . . . . . . . . . . . . . . . . .
Bayer (Aspirin Regimen) . . .
Bayer (Extra Strength) . . . . .
Bayer Aspirin (Genuine) . . . .
Bayer Back & Body Pain . . .
BC Powders . . . . . . . . . . . . .
Bio Electro . . . . . . . . . . . . . .
Bufferin . . . . . . . . . . . . . . . .
Ecotrin . . . . . . . . . . . . . . . . .
Equate . . . . . . . . . . . . . . . . .
Excedrin Extra Strength . . . .
Excedrin Migraine. . . . . . . . .
Excedrin PM. . . . . . . . . . . . .
Excedrin Tension Headache
Goody’s . . . . . . . . . . . . . . . .
Motrin IB. . . . . . . . . . . . . . . .
Motrin PM. . . . . . . . . . . . . . .
St. Joseph. . . . . . . . . . . . . . .
Tylenol Arthritis . . . . . . . . . . .
Tylenol 8 Hour . . . . . . . . . . .
Tylenol Extra Strength . . . . .
Tylenol PM . . . . . . . . . . . . . .
Tylenol Regular Strength . . .
Generic (No Label). . . . . . . .
PAIN RELIEVING RUBS,
LIQUIDS & PATCHES
(Nonprescription)
Store’s Own Brand . . . . . . . . OTHER (Write In)
Used for:
Arthritis/Rheumatism . . . . . .
Backaches . . . . . . . . . . . . . .
Colds . . . . . . . . . . . . . . . . . .
Flu/Fever . . . . . . . . . . . . . . .
Headaches . . . . . . . . . . . . . .
1
2
3
4
5
Heart Attack Prevention . . . .
Joint Pain . . . . . . . . . . . . . . .
Menstrual Cramps . . . . . . . .
Muscle Aches & Pains . . . . .
Oral Discomfort . . . . . . . . . .
6
7
8
9
0
076-0
Sleeplessness . . . . . . . . . . . X
Sports Related Injuries. . . . . Y
14S-0
Other . . . . . . . . . . . . . . . . . . 1
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
999
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Aspirin Formula . . . . . . . . . .
Non-Aspirin Formula . . . . . .
KINDS:
Caplets . . . . . . . . . . . . . . . . .
Capsules . . . . . . . . . . . . . . .
Effervescent . . . . . . . . . . . . .
Liquid . . . . . . . . . . . . . . . . . .
LiquiGels/LiquiCaps . . . . . . .
Nasal Sprays . . . . . . . . . . . .
Nasal Strips . . . . . . . . . . . . .
Tablets . . . . . . . . . . . . . . . . .
BRANDS:
Advil Allergy Sinus . . . . . . . .
Advil Cold & Sinus . . . . . . . .
Advil Congestion Relief . . . .
Airborne . . . . . . . . . . . . . . . .
Alavert . . . . . . . . . . . . . . . . .
Aleve-D Sinus & Cold . . . . .
Alka-Seltzer Plus Cold . . . . .
Alka-Seltzer Plus Cold &
Cough . . . . . . . . . . . . . . . .
Alka-Seltzer Plus Night . . . . .
Allegra Allergy. . . . . . . . . . . .
Allegra-D. . . . . . . . . . . . . . . .
Benadryl Allergy . . . . . . . . . .
Other Benadryl . . . . . . . . . . .
Breathe Right . . . . . . . . . . . .
Chlor-Trimeton . . . . . . . . . . .
Claritin . . . . . . . . . . . . . . . . .
Claritin-D . . . . . . . . . . . . . . .
Cold-Eeze. . . . . . . . . . . . . . .
Coricidin HBP . . . . . . . . . . .
Dimetapp . . . . . . . . . . . . . . .
Emergen-C . . . . . . . . . . . . . .
Equate . . . . . . . . . . . . . . . . .
Flonase OTC . . . . . . . . . . . .
Mentholatum Ointment. . . . .
Mucinex . . . . . . . . . . . . . . . .
Nasacort Allergy 24HR. . . . .
Robitussin. . . . . . . . . . . . . . .
Sudafed Congestion. . . . . . .
Sudafed PE Pressure + Pain
Other Sudafed . . . . . . . . . . .
Theraflu . . . . . . . . . . . . . . . .
Theraflu Nighttime Severe
Cold & Cough . . . . . . . . . .
Tylenol Cold . . . . . . . . . . . . .
Tylenol Sinus . . . . . . . . . . . .
Vicks DayQuil . . . . . . . . . . . .
Vicks NyQuil . . . . . . . . . . . . .
Vicks NyQuil LiquiCaps . . . .
Vicks QlearQuil. . . . . . . . . . .
Vicks VapoRub . . . . . . . . . . .
Zicam . . . . . . . . . . . . . . . . . .
Zyrtec . . . . . . . . . . . . . . . . . .
Zyrtec-D . . . . . . . . . . . . . . . .
OTHER (Write In)
Used for:
Allergy/Hay Fever . . . . . . . . .
Body Aches . . . . . . . . . . . . .
Colds . . . . . . . . . . . . . . . . . .
Cough. . . . . . . . . . . . . . . . . .
Flu/Fever . . . . . . . . . . . . . . .
Headaches . . . . . . . . . . . . .
Sinus Headache . . . . . . . . .
Sinus Congestion . . . . . . . .
Other . . . . . . . . . . . . . . . . . .
You Personally:
Used in
Times/
last 6
last 30
months
days
071
078
................. TOTAL:
You Personally:
Used in
Times/
last 6
last 30
months
days
00
01
02
079-0
1
2
3
4
5
6
7
8
9
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
999
TOTAL: . . . . . . . . . . . . . . . . . .
TYPES:
Cold Compress. . . . . . . . . . .
Heat Wrap . . . . . . . . . . . . . .
Lotion . . . . . . . . . . . . . . . . . .
Liquid . . . . . . . . . . . . . . . . . .
Ointment. . . . . . . . . . . . . . . .
Patch . . . . . . . . . . . . . . . . . .
Roll-on . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . .
BRANDS:
Absorbine Jr.. . . . . . . . . . . . .
Aspercreme . . . . . . . . . . . . .
Australian Dream . . . . . . . . .
Bengay . . . . . . . . . . . . . . . . .
Blue-Emu . . . . . . . . . . . . . . .
Capzasin . . . . . . . . . . . . . . .
Dragon . . . . . . . . . . . . . . . . .
Flexall . . . . . . . . . . . . . . . . . .
HeadOn . . . . . . . . . . . . . . . .
Icy Hot . . . . . . . . . . . . . . . . .
Icy Hot Smart Relief . . . . . . .
JointFlex . . . . . . . . . . . . . . . .
Mentholatum Deep Heating
Rub . . . . . . . . . . . . . . . . . .
Mineral Ice . . . . . . . . . . . . . .
Salonpas . . . . . . . . . . . . . . .
Sportscreme. . . . . . . . . . . . .
Stopain Cold. . . . . . . . . . . . .
Thera-Gesic . . . . . . . . . . . . .
ThermaCare . . . . . . . . . . . . .
Tiger Balm . . . . . . . . . . . . . .
WellPatch Pads . . . . . . . . . .
OTHER (Write In)
Used for:
Arthritis pain . . . . . . . . . . . . .
Backache . . . . . . . . . . . . . . .
Injury . . . . . . . . . . . . . . . . . .
Sore muscle pain . . . . . . . . .
Other . . . . . . . . . . . . . . . . . .
MEDICATED SKIN
OINTMENTS,
CREAMS, LOTIONS
& SPRAYS
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
999
072-0
1
2
3
4
5
You Personally:
Used in
Times/
last 6
last 30
months
days
073
TOTAL: . . . . . . . . . . . . . . . . . .
BRANDS:
Aveeno . . . . . . . . . . . . . . . . .
Bacitracin . . . . . . . . . . . . . . .
Bactine . . . . . . . . . . . . . . . . .
Benadryl . . . . . . . . . . . . . . . .
Caladryl . . . . . . . . . . . . . . . .
00
01
02
03
04
05
Cortaid . . . . . . . . . . . . . . . . .
Cortizone 10 . . . . . . . . . . . . .
Gold Bond Cream. . . . . . . . .
Lanacane . . . . . . . . . . . . . . .
Mederma . . . . . . . . . . . . . . .
06
07
08
09
10
Neosporin. . . . . . . . . . . . . . .
Neosporin + Pain Relief . . . .
Neo to Go! . . . . . . . . . . . . . .
Polysporin. . . . . . . . . . . . . . .
Tricalm . . . . . . . . . . . . . . . . .
11
12
13
14
15
Store’s Own Brand . . . . . . . . 999
OTHER (Write In)
Used for:
Antibiotic. . . . . . . . . . . . . . . .
Anti-itch . . . . . . . . . . . . . . . .
Pain Relief . . . . . . . . . . . . . .
Rash Relief. . . . . . . . . . . . . .
Scar Treatment . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . .
14G-0
1
2
3
4
5
6
16
HEALTH AIDS
Page 13
HEARTBURN,
INDIGESTION, GAS
& DIARRHEA
REMEDIES
You Personally:
Used in
Times/
last 6
last 30
months
days
HEMORRHOID
REMEDIES
You Personally:
Used in
Times/
last 6
last 30
months
days
VITAMIN AND
DIETARY
SUPPLEMENTS
085
082
TOTAL: . . . . . . . . . . . . . . . . . .
TYPES:
Caplet . . . . . . . . . . . . . . . . .
Liquid. . . . . . . . . . . . . . . . . .
Seltzer . . . . . . . . . . . . . . . . .
Chewable tablet . . . . . . . . . .
Other tablet . . . . . . . . . . . . .
BRANDS:
Alka Seltzer Extra Strength .
Alka Seltzer Heartburn . . . .
Alka Seltzer Original . . . . . .
Beano . . . . . . . . . . . . . . . . .
Gas-X . . . . . . . . . . . . . . . . .
Gaviscon . . . . . . . . . . . . . . .
Imodium AD. . . . . . . . . . . . .
Imodium Multi-Symptom . . .
Kaopectate . . . . . . . . . . . . .
Maalox . . . . . . . . . . . . . . . . .
Mylanta . . . . . . . . . . . . . . . .
Nexium 24HR (OTC) . . . . .
Pepcid AC . . . . . . . . . . . . . .
Pepcid AC Max Strength . . .
Pepcid Complete . . . . . . . . .
Pepto-Bismol Max Strength .
Pepto-Bismol Original . . . . .
Other Pepto-Bismol . . . . . . .
Prevacid 24HR (OTC) . . . . .
Prilosec OTC . . . . . . . . . . . .
Rolaids . . . . . . . . . . . . . . . .
Rolaids Extra Strength . . . .
Other Rolaids . . . . . . . . . . .
Tums Regular . . . . . . . . . . .
Tums Extra. . . . . . . . . . . . . .
Tums Smoothies . . . . . . . . .
Tums Ultra . . . . . . . . . . . . . .
Other Tums . . . . . . . . . . . . .
Zantac 75 . . . . . . . . . . . . . .
Zantac 150 . . . . . . . . . . . . .
Store’s Own Brand. . . . . . . .
TOTAL:
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
999
OTHER (Write In)
Used for:
Upset Stomach. . . . . . . . . . .
Heartburn . . . . . . . . . . . . . . .
Indigestion . . . . . . . . . . . . . .
Diarrhea . . . . . . . . . . . . . . . .
Gas. . . . . . . . . . . . . . . . . . . .
Bloating . . . . . . . . . . . . . . . .
14H-0
1
2
3
4
5
6
................. TYPES:
Creams. . . . . . . . . . . . . . . . .
Suppositories . . . . . . . . . . . .
Pads . . . . . . . . . . . . . . . . . . .
Wipes . . . . . . . . . . . . . . . . . .
BRANDS:
Preparation H . . . . . . . . . . . .
Tucks . . . . . . . . . . . . . . . . . .
OTHER (Write In)
ATHLETE’S FOOT/
MEDICATED FOOT
CARE PRODUCTS
TOTAL:
01
02
03
04
05
06
07
999
You Personally:
Used in
Times/
last 6
last 30
months
days
086
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Aerosol Liquid. . . . . . . . . . . .
Aerosol Powder . . . . . . . . . .
Other Powder . . . . . . . . . . . .
Cream. . . . . . . . . . . . . . . . . .
Gel . . . . . . . . . . . . . . . . . . . .
Liquid . . . . . . . . . . . . . . . . . .
BRANDS:
Desenex . . . . . . . . . . . . . . . .
Dr. Paul’s Piggy Paste . . . . .
Fungicure . . . . . . . . . . . . . . .
Fungi-Nail . . . . . . . . . . . . . . .
Kerasal Nail . . . . . . . . . . . . .
Lamisil . . . . . . . . . . . . . . . . .
Lotrimin . . . . . . . . . . . . . . . .
Tinactin . . . . . . . . . . . . . . . . .
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
999
OTHER (Write In)
PRE-MENSTRUAL OR
PERIOD PAIN
REMEDIES (Women)
You Personally:
Used in
Times/
last 6
last 30
months
days
088
TOTAL: . . . . . . . . . . . . . . . . . BRANDS:
Midol. . . . . . . . . . . . . . . . . . . Pamprin . . . . . . . . . . . . . . . . 00
01
02
999
OTHER (Write In)
LAXATIVES/
FIBER
SUPPLEMENTS
You Personally:
Used in
Times/
last 6
last 30
months
days
FEMININE MEDICATED
PRODUCTS (Women)
083
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Benefiber . . . . . . . . . . . . . . .
Citrucel . . . . . . . . . . . . . . . .
Colace . . . . . . . . . . . . . . . . .
Dulcolax . . . . . . . . . . . . . . . .
Ex-Lax . . . . . . . . . . . . . . . . .
Fiber Choice . . . . . . . . . . . .
Fleet . . . . . . . . . . . . . . . . . .
Metamucil . . . . . . . . . . . . . .
Miralax . . . . . . . . . . . . . . . . .
Phillips’ Fiber Good . . . . . . .
Phillips’ Milk of Magnesia. . .
Senokot . . . . . . . . . . . . . . . .
Vitafusion Fiber Gummies . .
Store’s Own Brand. . . . . . . .
You Personally:
Used in
Times/
last 6
last 30
months
days
089
OTHER (Write In)
Used for:
15U-0
Dietary Supplement . . . . . . . 1
Regularity . . . . . . . . . . . . . . . 2
Laxative . . . . . . . . . . . . . . . . 3
Other . . . . . . . . . . . . . . . . . . 4
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
999
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Cortisone 10
Feminine Relief. . . . . . . . .
Monistat 1 . . . . . . . . . . . . . .
Monistat 3 . . . . . . . . . . . . . .
Monistat 7 . . . . . . . . . . . . . .
Vagisil Anti-Itch . . . . . . . . . .
00
01
02
03
04
05
Store’s Own Brand . . . . . . . . 06
999
OTHER (Write In)
PERSONAL
LUBRICANTS
You Personally:
Used in
last 6
months
Yes . . . . . . . . . . . . . . . . . . . . . . .
BRANDS:
Astroglide . . . . . . . . . . . . . . . .
K-Y . . . . . . . . . . . . . . . . . . . . .
Trojan Lubricants . . . . . . . . . .
Store’s Own Brand . . . . . . . . .
OTHER (Write In)
080
00
087-0
1
2
3
4
5
6
You Personally:
Used in
Times/
last 6
last 7
months
days
................. TYPES:
A. . . . . . . . . . . . . . . . . . . . . .
Antioxidant Vitamins . . . . . . .
B Complex . . . . . . . . . . . . . .
B-6 . . . . . . . . . . . . . . . . . . . .
B-12 . . . . . . . . . . . . . . . . . . .
Beta Carotene . . . . . . . . . . .
C. . . . . . . . . . . . . . . . . . . . . .
Calcium Supplement . . . . . .
D. . . . . . . . . . . . . . . . . . . . . .
E. . . . . . . . . . . . . . . . . . . . . .
Echinacea . . . . . . . . . . . . . .
Folic Acid . . . . . . . . . . . . . . .
Garlic Supplements . . . . . . .
Gingko Biloba . . . . . . . . . . . .
Ginseng . . . . . . . . . . . . . . . .
Glucosamine . . . . . . . . . . . .
Iron . . . . . . . . . . . . . . . . . . . .
Multiple Formula. . . . . . . . . .
Multiple Formula with Iron . .
Multiple Formula with
Minerals . . . . . . . . . . . . . .
Omega 3/Fish Oil . . . . . . . . .
Prenatal . . . . . . . . . . . . . . . .
Probiotic . . . . . . . . . . . . . . . .
St. John’s Wort . . . . . . . . . . .
Stress Formula . . . . . . . . . . .
Zinc . . . . . . . . . . . . . . . . . . . Other . . . . . . . . . . . . . . . . . . BRANDS:
Bausch + Lomb
PreserVision . . . . . . . . . . .
Bayer Pro Ultra Omega-3 . . .
Caltrate 600 . . . . . . . . . . . . .
Centrum . . . . . . . . . . . . . . . .
Centrum Energy . . . . . . . . . .
Centrum Flavor Burst Chews
Centrum Heart . . . . . . . . . . .
Centrum Silver . . . . . . . . . . .
Other Centrum . . . . . . . . . . .
Citracal . . . . . . . . . . . . . . . . .
Emergen-C . . . . . . . . . . . . . .
Ester-C . . . . . . . . . . . . . . . . .
Nature Made. . . . . . . . . . . . .
Nature’s Bounty . . . . . . . . . .
Nature’s Way Alive! . . . . . . . .
Ocuvite . . . . . . . . . . . . . . . . .
One-A-Day 50+ Advantage. .
One-A-Day Men’s Health . . .
One-A-Day Women’s
Active Metabolism. . . . . . .
One-A-Day Women’s . . . . . .
One-A-Day VitaCraves . . . . .
Other One-A-Day . . . . . . . . .
Os-Cal . . . . . . . . . . . . . . . . .
Osteo Bi-Flex . . . . . . . . . . . .
Renew Life Ultimate Flora . .
Rolaids . . . . . . . . . . . . . . . . .
Schiff . . . . . . . . . . . . . . . . . .
Sundown Naturals . . . . . . . .
TruBiotics . . . . . . . . . . . . . . .
Viactiv. . . . . . . . . . . . . . . . . .
Vitafusion . . . . . . . . . . . . . . . Store’s Own Brand . . . . . . . . OTHER (Write In)
Used for:
14A-0
General Health . . . . . . . . . . . 1
Vitamin/Mineral Deficiency . . 2
Prenatal Care . . . . . . . . . . . . 3
Other . . . . . . . . . . . . . . . . . . 4
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
999
PERSONAL CARE, DIET AND BODY CARE PRODUCTS
BODY POWDER
You Personally:
Used in
Times/
last 6
last 7
months
days
MEAL/DIETARY/
WEIGHT LOSS
SUPPLEMENTS
00
01
02
03
04
05
Shower to Shower . . . . . . . . 06
999
OTHER (Write In)
DIET CONTROL/
EATING HABITS
Are you presently controlling your diet?
Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If yes, reason for diet control:
Blood sugar level . . . . . . . . . . . . . . . . . . . . .
Cholesterol level . . . . . . . . . . . . . . . . . . . . . .
Food Allergy . . . . . . . . . . . . . . . . . . . . . . . . .
Lactose intolerance . . . . . . . . . . . . . . . . . . .
Maintain weight . . . . . . . . . . . . . . . . . . . . . .
Physical fitness. . . . . . . . . . . . . . . . . . . . . . .
Regularity . . . . . . . . . . . . . . . . . . . . . . . . . . .
Salt restriction. . . . . . . . . . . . . . . . . . . . . . . .
Weight loss . . . . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Do you buy foods specifically
labeled as:
Fat-free . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Gluten-free . . . . . . . . . . . . . . . . . . . . . . . . . .
High fiber . . . . . . . . . . . . . . . . . . . . . . . . . . .
High protein . . . . . . . . . . . . . . . . . . . . . . . . .
Lactose-free . . . . . . . . . . . . . . . . . . . . . . . . .
Low-calorie . . . . . . . . . . . . . . . . . . . . . . . . . .
Low-carb. . . . . . . . . . . . . . . . . . . . . . . . . . . .
Low-cholesterol . . . . . . . . . . . . . . . . . . . . . .
Low-fat . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Low-sodium . . . . . . . . . . . . . . . . . . . . . . . . .
Natural or Organic . . . . . . . . . . . . . . . . . . . .
Probiotic . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Sugar-free. . . . . . . . . . . . . . . . . . . . . . . . . . .
Do you consider yourself to be:
Semi-vegetarian . . . . . . . . . . . . . . . . . . . . . .
Vegetarian . . . . . . . . . . . . . . . . . . . . . . . . . .
Vegan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
095-0
1
2
3
4
5
6
7
8
9
0
X
096-0
1
2
3
4
5
6
7
8
9
0
15R-0
1
2
3
4
5
6
If you are dieting, which methods are you using:
Cooking Light diet. . . . . . . . . . . . . . . . . . . . .
Jenny Craig . . . . . . . . . . . . . . . . . . . . . . . . .
Medifast . . . . . . . . . . . . . . . . . . . . . . . . . . . .
MyFitnessPal.com . . . . . . . . . . . . . . . . . . . .
Nutrisystem . . . . . . . . . . . . . . . . . . . . . . . . .
South Beach Diet . . . . . . . . . . . . . . . . . . . . .
Weight Watchers . . . . . . . . . . . . . . . . . . . . .
Other diet organization or club . . . . . . . . . . .
097-0
1
2
3
4
5
6
7
8
Atkins diet. . . . . . . . . . . . . . . . . . . . . . . . . . .
Doctor’s care/diet . . . . . . . . . . . . . . . . . . . . .
Diet control book . . . . . . . . . . . . . . . . . . . . .
Exercise program . . . . . . . . . . . . . . . . . . . . .
9
0
X
Y
Surgery. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14W-0
1
2
You Personally:
Used in
Times/
last 6
last 30
months
days
098
TOTAL: . . . . . . . . . . . . . . . . . BRANDS:
Dairy Ease . . . . . . . . . . . . . . Lactaid . . . . . . . . . . . . . . . . . OTHER (Write In)
SUNTAN &
SUNSCREEN
PRODUCTS
099
009
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Avon . . . . . . . . . . . . . . . . . . .
Burt’s Bees. . . . . . . . . . . . . .
Gold Bond Powder . . . . . . . .
Johnson’s Baby Powder . . . .
Johnson’s Baby Powder
Pure Corn Starch . . . . . . .
LACTOSE
INTOLERANCE
PRODUCTS
You Personally:
Used in
Times/
last 6
last 7
months
days
00
01
02
999
OTHER (Write In)
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
999
Used For:
15Q-0
Weight Loss . . . . . . . . . . . . . 1
Gain/Maintain Weight . . . . . . 2
Nutritional Supplement. . . . . 3
Meal Replacement . . . . . . . . 4
You Personally:
Used in
Bought in
last 6
last 6
months
months
101
1
2
Yes . . . . . . . . . . . . . . . . . . . . BRANDS:
Always Discreet . . . . . . . . . . .
Depend . . . . . . . . . . . . . . . . .
Poise . . . . . . . . . . . . . . . . . . .
Tena Serenity . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . .
01
02
03
04
05
06
You Personally:
Bought in
last 6
months
CONDOMS
Yes . . . . . . . . . . . . . . . . . . . . . . .
BRANDS:
Durex . . . . . . . . . . . . . . . . . . . . .
LifeStyles . . . . . . . . . . . . . . . . . .
Trojan . . . . . . . . . . . . . . . . . . . . .
Trojan Ecstasy . . . . . . . . . . . . . .
Trojan Her Pleasure . . . . . . . . . .
Trojan Magnum. . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . .
BLEACH AND
DEPILATORIES
(Hair Removal)
102-0
1
................. TYPES:
SPF 0 (no SPF) . . . . . . . . . .
SPF 1-10. . . . . . . . . . . . . . . .
SPF 15 . . . . . . . . . . . . . . . .
SPF 30-49 . . . . . . . . . . . . . .
SPF 50+ . . . . . . . . . . . . . . .
KINDS:
Suntan Lotion/Sunscreen . . . Sunless Tanner. . . . . . . . . . . FORMS:
Gel . . . . . . . . . . . . . . . . . . . .
Lotion . . . . . . . . . . . . . . . . . .
Oil. . . . . . . . . . . . . . . . . . . . .
Spray . . . . . . . . . . . . . . . . . .
Stick . . . . . . . . . . . . . . . . . . .
Tube (cream) . . . . . . . . . . . .
BRANDS:
Australian Gold . . . . . . . . . . .
Aveeno . . . . . . . . . . . . . . . . .
Avon . . . . . . . . . . . . . . . . . . .
Bain de Soleil . . . . . . . . . . . .
Banana Boat . . . . . . . . . . . .
Banana Boat Sport. . . . . . . .
Bull Frog . . . . . . . . . . . . . . . .
CeraVé . . . . . . . . . . . . . . . . .
Clinique . . . . . . . . . . . . . . . .
Coppertone Sport. . . . . . . . .
Other Coppertone . . . . . . . .
Hawaiian Tropic . . . . . . . . . .
L’Oréal Sublime Bronze . . . .
L’Oréal Advanced Suncare . .
Mary Kay . . . . . . . . . . . . . . .
Neutrogena Sunblock. . . . . .
Neutrogena Sunless Tan . . .
Other Neutrogena . . . . . . . .
No-Ad . . . . . . . . . . . . . . . . .
Ocean Potion . . . . . . . . . . . .
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
999
OTHER (Write In)
2
3
4
5
6
SUNBURN
REMEDIES
You Personally:
Used in
Times/last
last 12
30 days
months
(in season)
106
7
8
TOTAL:
................. TYPES:
Cream. . . . . . . . . . . . . . . . . . Gel . . . . . . . . . . . . . . . . . . . . Spray . . . . . . . . . . . . . . . . . . 104
TOTAL:
Panama Jack . . . . . . . . . . . . Sally Hansen Airbrush Legs . Store’s Own Brand . . . . . . . . You Personally:
Used in
Times/
last 6
last 30
months
days
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Bleach . . . . . . . . . . . . . . . . .
Cream. . . . . . . . . . . . . . . . . .
Gel . . . . . . . . . . . . . . . . . . . .
Hair Removal Device . . . . . .
Lotion . . . . . . . . . . . . . . . . . .
Spray . . . . . . . . . . . . . . . . . .
Wax Strips . . . . . . . . . . . . . .
Other Wax . . . . . . . . . . . . . .
BRANDS:
Jolen. . . . . . . . . . . . . . . . . . .
Nair. . . . . . . . . . . . . . . . . . . .
Olay . . . . . . . . . . . . . . . . . . .
Sally Hansen . . . . . . . . . . . .
Veet . . . . . . . . . . . . . . . . . . .
OTHER (Write In)
You Personally:
Used in
Times/last
last 12
30 days
months
(in season)
105
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Liquid . . . . . . . . . . . . . . . . . .
Powder . . . . . . . . . . . . . . . . .
Tablet . . . . . . . . . . . . . . . . . .
BRANDS:
Alli. . . . . . . . . . . . . . . . . . . . .
Atkins . . . . . . . . . . . . . . . . . .
Body Fortress. . . . . . . . . . . .
Boost . . . . . . . . . . . . . . . . . .
Carnation Breakfast
Essentials . . . . . . . . . . . . .
EAS . . . . . . . . . . . . . . . . . . .
Ensure . . . . . . . . . . . . . . . . .
Fastin . . . . . . . . . . . . . . . . . .
Hydroxycut . . . . . . . . . . . . . .
Isopure . . . . . . . . . . . . . . . . .
Kellogg’s Special K Protein. .
Muscle Milk . . . . . . . . . . . . .
Purely Inspired . . . . . . . . . . .
Slim-Fast . . . . . . . . . . . . . . .
SlimQuick . . . . . . . . . . . . . . .
INCONTINENCE
PRODUCTS
Page 14
00
01
02
03
04
05
06
07
08
09
10
11
12
13
999
BRANDS:
Bactine . . . . . . . . . . . . . . . . .
Banana Boat . . . . . . . . . . . .
Lanacane Spray . . . . . . . . . .
Noxzema . . . . . . . . . . . . . . .
Solarcaine . . . . . . . . . . . . . . Natural/Home Remedy. . . . . OTHER (Write In)
00
01
02
03
04
05
06
07
08
09
999
IN HOME SHOPPING/HEALTH AIDS/SMOKING/TOBACCO
Page 15
IN HOME
SHOPPING
In the last 6 months, did you personally buy
items from an in-home sales representative? 14N-0
Yes 1
Amount spent in last 6 months:
14P-0
Under $50 . . . . . . . . . . . . . . . . . . . . . . . . . 1
$50-$74 . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
$75-$149 . . . . . . . . . . . . . . . . . . . . . . . . . . 3
$150 or more . . . . . . . . . . . . . . . . . . . . . . . 4
Items purchased:
653-0
Cosmetics. . . . . . . . . . . . . . . . . . . . . . . . . . 5
Housewares . . . . . . . . . . . . . . . . . . . . . . . . 6
Clothing . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Jewelry . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Vitamins . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0
From which company did you purchase
in the last 6 months?
14Q-0
Amway . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Avon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Mary Kay Cosmetics . . . . . . . . . . . . . . . . . 3
Pampered Chef . . . . . . . . . . . . . . . . . . . . . 4
Tupperware. . . . . . . . . . . . . . . . . . . . . . . . . 5
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
TOOTHACHE, GUM
& CANKER SORE
REMEDIES
You Personally:
Used
Pipesful/
in last 6
last 7
days
months
PIPE TOBACCO
You Personally:
Used
Times/
in last 6
last 30
months
days
00
01
02
03
04
05
999
...............
CIGARETTE
ROLLING PAPERS
................. BRANDS:
EZ Wider . . . . . . . . . . . . . . . Zig Zag . . . . . . . . . . . . . . . . . 119
................. TYPES:
Loose Leaf . . . . . . . . . . . . . .
Moist Smokeless/Snuff . . . . .
Pouch . . . . . . . . . . . . . . . . . .
Snus . . . . . . . . . . . . . . . . . . .
BRANDS:
Camel Snus . . . . . . . . . . . . .
Copenhagen. . . . . . . . . . . . .
Grizzly . . . . . . . . . . . . . . . . .
Skoal . . . . . . . . . . . . . . . . . .
ELECTRONIC/
E-CIGARETTES/
VAPORIZERS
00
01
02
03
04
05
06
07
999
OTHER (Write In)
Number of cold sores/fever blisters you
had, last 6 months
14E-0
Write in number
OTHER (Write In)
SLEEPING AIDS &
SNORE RELIEF
OTHER (Write In)
Used for:
14F-0
Snore Relief . . . . . . . . . . . . . 1
Sleeplessness . . . . . . . . . . . 2
02
03
04
05
06
08
TYPES:
E-Cig . . . . . . . . . . . . . . . . . . Vaporizer . . . . . . . . . . . . . . . 01
Mistic . . . . . . . . . . . . . . . . . .
NJoy . . . . . . . . . . . . . . . . . . .
V2 Cigs. . . . . . . . . . . . . . . . .
VUSE . . . . . . . . . . . . . . . . . .
BRANDS:
Basic . . . . . . . . . . . . . . . . . .
Camel Blue/Silver . . . . . . . . .
Camel Regular . . . . . . . . . . .
Other Camel . . . . . . . . . . . . .
Kool . . . . . . . . . . . . . . . . . . .
L&M . . . . . . . . . . . . . . . . . . .
Marlboro Black . . . . . . . . . . .
Marlboro Gold . . . . . . . . . . .
Marlboro Red . . . . . . . . . . . .
Marlboro Silver . . . . . . . . . . .
Marlboro Special Blend . . . .
Other Marlboro . . . . . . . . . . .
Maverick . . . . . . . . . . . . . . . .
Misty. . . . . . . . . . . . . . . . . . .
Natural American Spirit . . . .
Newport . . . . . . . . . . . . . . . .
Pall Mall . . . . . . . . . . . . . . . .
Parliament . . . . . . . . . . . . . .
Pyramid . . . . . . . . . . . . . . . .
Salem . . . . . . . . . . . . . . . . . .
305’s. . . . . . . . . . . . . . . . . . .
Virginia Slims . . . . . . . . . . . .
Winston. . . . . . . . . . . . . . . . .
01
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
999
OTHER (Write In)
999
00
02
07
You Personally:
Smoked
Cartridges/
in last
last 7
days
12 months
BRANDS:
blu eCigs . . . . . . . . . . . . . . .
Green Smoke . . . . . . . . . . . .
Juul. . . . . . . . . . . . . . . . . . . .
LOGIC . . . . . . . . . . . . . . . . .
MarkTen . . . . . . . . . . . . . . . .
00
02
03
04
05
06
07
08
09
SMOKING
CESSATION
Method(s) used to stop smoking, last 12 months:
“Cold Turkey” . . . . . . . . . . . . . . . . . . .
Electronic/E-cigarette . . . . . . . . . . . . .
Gum . . . . . . . . . . . . . . . . . . . . . . . . . .
Lozenge . . . . . . . . . . . . . . . . . . . . . . .
Patch . . . . . . . . . . . . . . . . . . . . . . . . .
Pill . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . .
14V-0
1
2
3
4
5
6
7
BRANDS:
114-0
Chantix . . . . . . . . . . . . . . . . . . . . . . . . 1
Nicorette . . . . . . . . . . . . . . . . . . . . . . 2
NicoDerm CQ. . . . . . . . . . . . . . . . . . . 3
Zonnic . . . . . . . . . . . . . . . . . . . . . . . . 4
Store’s Own Brand . . . . . . . . . . . . . . . 5
Other . . . . . . . . . . . . . . . . . . . . . . . . . 6
10
11
999
CIGARS
You Personally:
Smoked
Number/
in last 6
last 7
days
months
113
TOTAL:
081
01
................. OTHER (Write In)
You Personally:
Used in
Times/
last 6
last 30
months
days
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Alteril . . . . . . . . . . . . . . . . . .
Breathe Right . . . . . . . . . . . .
Dalay . . . . . . . . . . . . . . . . . .
Melatonex. . . . . . . . . . . . . . .
MidNite . . . . . . . . . . . . . . . . .
Nature Made Sleep . . . . . . .
Simply Sleep . . . . . . . . . . . .
Unisom . . . . . . . . . . . . . . . . .
ZzzQuil . . . . . . . . . . . . . . . . .
00
14C
TOTAL:
14D
999
OTHER (Write In)
You Personally:
Used
Times/
in last 6
last 30
days
months
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Abreva . . . . . . . . . . . . . . . . .
Anbesol Cold Sore Therapy .
Blistex Medicated Lip
Ointment . . . . . . . . . . . . . .
Campho-Phenique Cold
Sore Treatment . . . . . . . . .
Carmex. . . . . . . . . . . . . . . . .
Herpecin-L . . . . . . . . . . . . . .
Orajel for Cold Sores . . . . . .
01
02
You Personally:
Cans/
Used
Packages
in last 6
last 30
days
months
OTHER (Write In)
Used for:
15K-0
Toothache. . . . . . . . . . . . . . . 1
Gum/Canker Sore . . . . . . . . 2
COLD SORES/
FEVER BLISTERS
00
OTHER (Write In)
CHEWING AND
SMOKELESS
TOBACCO
................. KINDS:
Menthol . . . . . . . . . . . . . . . . Non-Menthol. . . . . . . . . . . . . TOTAL:
You Personally:
Used
Packets/
in last 6
last 7
days
months
Packs/
last 7
days
104
115
00
118
TOTAL:
TOTAL:
062
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Anbesol . . . . . . . . . . . . . . . .
Colgate Orabase . . . . . . . . .
Kank-A . . . . . . . . . . . . . . . . .
Orajel Mouth Sore . . . . . . . .
Orajel Toothache . . . . . . . . .
117
TOTAL:
You Personally:
Smoked
in last 12
months
CIGARETTES
00
01
02
03
04
05
06
07
08
09
999
................. BRANDS:
Black & Mild . . . . . . . . . . . . .
Dutch Masters . . . . . . . . . . .
Garcia y Vega . . . . . . . . . . . .
Macanudo . . . . . . . . . . . . . .
Montecristo. . . . . . . . . . . . . .
00
01
02
03
04
05
Swisher Sweets . . . . . . . . . . White Owl . . . . . . . . . . . . . . . 06
07
999
OTHER (Write In)
AILMENTS/DOCTOR VISITS
Page 16
You Personally:
AILMENTS/
REMEDIES
Have/
Had in
last 12
months
How treated in the last 12 months?
Used a prescription
remedy
Branded
Generic
Used a
nonprescription
remedy
DOCTOR
DOCTOR
VISITS
VISITS
Used a
home/
herbal
remedy
Have not
treated
AILMENTS
107
Acne . . . . . . . . . . . . . . . . . . . . . . . .
ADD/ADHD. . . . . . . . . . . . . . . . . . .
Allergy/Hay Fever . . . . . . . . . . . . . .
Anxiety/Panic . . . . . . . . . . . . . . . . .
Arthritis/Rheumatoid arthritis (RA) .
1
2
3
4
5
6
Arthritis/Osteoarthritis. . . . . . . . . . .
Asthma . . . . . . . . . . . . . . . . . . . . . .
Athlete’s Foot . . . . . . . . . . . . . . . . .
Atrial Fibrillation (Afib) . . . . . . . . . .
Backache/Back Pain . . . . . . . . . . . .
Bipolar Disorder . . . . . . . . . . . . . . .
Cancer . . . . . . . . . . . . . . . . . . . . . .
Crohn’s Disease/Ulcerative Colitis .
Chronic Bronchitis. . . . . . . . . . . . . .
Chronic/Severe Pain . . . . . . . . . . . .
Cold Sores . . . . . . . . . . . . . . . . . . .
Constipation . . . . . . . . . . . . . . . . . .
Dandruff/Dry Scalp . . . . . . . . . . . . .
Depression . . . . . . . . . . . . . . . . . . .
Diabetes (Insulin Dependent) . . . . .
Diabetes (Non-Insulin Dependent) .
Dry Eyes . . . . . . . . . . . . . . . . . . . . .
Eczema/Skin Itch/Rash . . . . . . . . .
Emphysema . . . . . . . . . . . . . . . . . .
Epilepsy/Seizures . . . . . . . . . . . . . .
Erectile Dysfunction (ED) . . . . . . . .
Fibromyalgia . . . . . . . . . . . . . . . . . .
Flu. . . . . . . . . . . . . . . . . . . . . . . . . .
Gout . . . . . . . . . . . . . . . . . . . . . . . .
Hair Loss . . . . . . . . . . . . . . . . . . . .
Hearing Loss . . . . . . . . . . . . . . . . .
Heart Attack/Heart Disease . . . . . .
Heartburn/Acid Reflux . . . . . . . . . .
Hepatitis . . . . . . . . . . . . . . . . . . . . .
High Cholesterol . . . . . . . . . . . . . . .
Hypertension/High Blood
Pressure . . . . . . . . . . . . . . . . . . .
Insomnia . . . . . . . . . . . . . . . . . . . . .
Irritable Bowel Syndrome (IBS) . . .
Kidney Ailments . . . . . . . . . . . . . . .
Macular Degeneration . . . . . . . . . .
Menopause/Hormone Replacement Migraine Headaches. . . . . . . . . . . . Multiple Sclerosis (MS) . . . . . . . . . Muscle Strain/Sprain . . . . . . . . . . . Nail Fungus. . . . . . . . . . . . . . . . . . . Obesity/Overweight . . . . . . . . . . . .
Osteoporosis . . . . . . . . . . . . . . . . .
Overactive Bladder . . . . . . . . . . . . .
Prostate. . . . . . . . . . . . . . . . . . . . . .
Psoriasis. . . . . . . . . . . . . . . . . . . . .
Restless Legs Syndrome . . . . . . . .
Rosacea or Skin Disease . . . . . . . .
Sinus Congestion/Headache . . . . .
Sleep Apnea . . . . . . . . . . . . . . . . . .
Snoring . . . . . . . . . . . . . . . . . . . . . .
Urinary Tract Infection (UTI) . . . . . . Wrinkles . . . . . . . . . . . . . . . . . . . . . Yeast Infection . . . . . . . . . . . . . . . . In the last 12 months, how did you obtain information about an ailment or prescription drug?
15A-0
Television Advertisement . . . . . . . . .
Magazine Advertisement . . . . . . . . .
Other Advertisement. . . . . . . . . . . . .
Doctor or Healthcare professional . .
Friends/Family . . . . . . . . . . . . . . . . .
Pamphlets/Brochures. . . . . . . . . . . .
1
2
3
4
5
6
14X-0
Patient support group . . . . . . . . . . . .
Pharmacist . . . . . . . . . . . . . . . . . . . .
Pharmaceutical company . . . . . . . . .
Medical journals . . . . . . . . . . . . . . . .
Social Media site . . . . . . . . . . . . . . .
Other Online/Internet site . . . . . . . . .
Other. . . . . . . . . . . . . . . . . . . . . . . . .
1
2
3
4
5
6
7
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
You Personally:
Visited
Times/
in last 12 last 12
months months
094
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Acupuncturist . . . . . . . . . . . .
Allergist. . . . . . . . . . . . . . . . .
Cardiologist . . . . . . . . . . . . .
Chiropractor . . . . . . . . . . . . .
Dentist . . . . . . . . . . . . . . . . .
Dermatologist . . . . . . . . . . . .
Ear, Nose & Throat. . . . . . . .
Eye Doctor . . . . . . . . . . . . . .
Gastroenterologist . . . . . . . .
General/Family Practitioner .
Internist . . . . . . . . . . . . . . . .
Nurse Practitioner. . . . . . . . .
OB/Gyn . . . . . . . . . . . . . . . .
Osteopath. . . . . . . . . . . . . . .
Pediatrician (with child) . . . .
Physical Therapist . . . . . . . .
Plastic Surgeon . . . . . . . . . .
Podiatrist . . . . . . . . . . . . . . .
Psychiatrist . . . . . . . . . . . . . .
Urologist . . . . . . . . . . . . . . . .
OTHER (Write In)
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
999
23
24
25
CAREGIVER/
CARETAKER
26
27
28
29
30
Are you, personally, a primary caregiver for
someone with a medical condition? Yes 1
If yes, what services/support do you provide?
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
15L-0
15N-0
Assist with chores. . . . . . . . . . . . .
Assist with personal care . . . . . . .
Give medication . . . . . . . . . . . . . .
Make doctor’s appointments. . . . .
Provide transportation . . . . . . . . .
Research medical information . . .
Other . . . . . . . . . . . . . . . . . . . . . .
1
2
3
4
5
6
7
Age of patient(s):
15W-0
Less than 18 years old . . . . . . 1
18-64 years old. . . . . . . . . . . . 2
65 years or older . . . . . . . . . . 3
Patient’s relationship to you: 15Y-0
Relative . . . . . . . . . . . . . . . . . 1
Friend . . . . . . . . . . . . . . . . . . . 2
Other . . . . . . . . . . . . . . . . . . . 3
48
49
50
HEALTHCARE
ADVERTISING
ACTIONS TAKEN
14B-0
51
52
53
54
55
56
57
58
Actions you took as a result of seeing or
hearing healthcare advertising, in the last
12 months:
Bought a non-prescription product . . . . .
Refilled a prescription. . . . . . . . . . . . . . .
Made an appointment to see a doctor . .
Discussed an ad with your doctor . . . . .
Discussed an ad with a friend or
relative . . . . . . . . . . . . . . . . . . . . . . . . .
Asked your doctor to prescribe a
specific drug . . . . . . . . . . . . . . . . . . . . .
Consulted a pharmacist . . . . . . . . . . . . .
Visited a product or drug website . . . . . .
Visited another website . . . . . . . . . . . . .
Requested a free sample . . . . . . . . . . . .
Called a toll-free number for information . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
2
3
4
5
6
7
8
9
0
X
Y
PRESCRIPTION DRUGS/HEALTH ATTITUDES
Page 17
You Personally:
Used
in last
12 months
PRESCRIPTION
DRUGS
108-0
BRANDS:
Abilify. . . . . . . . . . . . . . . . . . . . . . . .
AcipHex . . . . . . . . . . . . . . . . . . . . . .
Actonel . . . . . . . . . . . . . . . . . . . . . .
Actos . . . . . . . . . . . . . . . . . . . . . . . .
Aczone . . . . . . . . . . . . . . . . . . . . . .
Adderall . . . . . . . . . . . . . . . . . . . . . .
Advair . . . . . . . . . . . . . . . . . . . . . . .
Ambien/Ambien CR. . . . . . . . . . . . .
Androgel . . . . . . . . . . . . . . . . . . . . .
1
2
3
4
5
6
7
8
9
109-0
1
2
3
4
5
Avodart . . . . . . . . . . . . . . . . . . . . . .
Belviq . . . . . . . . . . . . . . . . . . . . . . .
Boniva . . . . . . . . . . . . . . . . . . . . . . .
Botox . . . . . . . . . . . . . . . . . . . . . . . .
Celebrex . . . . . . . . . . . . . . . . . . . . .
Cialis . . . . . . . . . . . . . . . . . . . . . . . .
Clarinex. . . . . . . . . . . . . . . . . . . . . .
Coreg . . . . . . . . . . . . . . . . . . . . . . .
Cosentyx . . . . . . . . . . . . . . . . . . . . .
Crestor . . . . . . . . . . . . . . . . . . . . . .
Cymbalta. . . . . . . . . . . . . . . . . . . . .
Diflucan . . . . . . . . . . . . . . . . . . . . . .
6
7
8
9
0
X
Y
110-0
Diovan/Diovan HCT . . . . . . . . . . . .
Dulera . . . . . . . . . . . . . . . . . . . . . . .
Effexor/Effexor XR . . . . . . . . . . . . . .
Eliquis . . . . . . . . . . . . . . . . . . . . . . .
Enbrel . . . . . . . . . . . . . . . . . . . . . . .
Evista . . . . . . . . . . . . . . . . . . . . . . .
Flomax . . . . . . . . . . . . . . . . . . . . . .
Flovent . . . . . . . . . . . . . . . . . . . . . .
Fosamax . . . . . . . . . . . . . . . . . . . . .
Glucophage/Glucophage XR . . . . .
Humira . . . . . . . . . . . . . . . . . . . . . .
1
2
3
4
5
6
7
8
9
0
X
131-0
Imitrex . . . . . . . . . . . . . . . . . . . . . . . 1
Januvia . . . . . . . . . . . . . . . . . . . . . . 2
Juvederm . . . . . . . . . . . . . . . . . . . . 3
HEALTH
ATTITUDES
PRESCRIPTION
DRUGS
(Continued)
You Personally:
Used
in last
12 months
PRESCRIPTION
DRUGS
(Continued)
Number of prescriptions filled for yourself in
the last 30 days
15E-0
15S-0
1
2
3
4
5
Lamisil. . . . . . . . . . . . . . . . . . . . . . .
Latuda . . . . . . . . . . . . . . . . . . . . . . .
Lexapro . . . . . . . . . . . . . . . . . . . . . .
Linzess . . . . . . . . . . . . . . . . . . . . . .
Lipitor . . . . . . . . . . . . . . . . . . . . . . .
Lovaza . . . . . . . . . . . . . . . . . . . . . .
Lyrica . . . . . . . . . . . . . . . . . . . . . . .
Nasonex . . . . . . . . . . . . . . . . . . . . .
Nexium . . . . . . . . . . . . . . . . . . . . . .
Norvasc. . . . . . . . . . . . . . . . . . . . . .
Orencia . . . . . . . . . . . . . . . . . . . . . .
Ortho Tri-cyclen. . . . . . . . . . . . . . .
Osphena . . . . . . . . . . . . . . . . . . . .
Paxil/Paxil CR . . . . . . . . . . . . . . . .
Plavix . . . . . . . . . . . . . . . . . . . . . .
Pradaxa. . . . . . . . . . . . . . . . . . . . .
Write in number
On the average, how much do you spend out
of pocket per month on your prescription
medication(s)?
$
15F-0
6
7
8
9
0
X
Write in amount
In the last 12 months, where did you fill a
prescription?
132-0
. 1
. 2
. 3
. 4
. 5
Pravachol . . . . . . . . . . . . . . . . . . . .
Prevacid . . . . . . . . . . . . . . . . . . . . .
Pristiq . . . . . . . . . . . . . . . . . . . . . . .
Prolia . . . . . . . . . . . . . . . . . . . . . . . .
Drug Store/Pharmacy . . . . . . . . . . .
Supermarket . . . . . . . . . . . . . . . . . .
Discount/Department Store. . . . . . .
Mail order . . . . . . . . . . . . . . . . . . . .
Internet/Online . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . .
6
7
8
9
You Personally:
CONTRACEPTION
(Women)
112-0
Protonix . . . . . . . . . . . . . . . . . . . . . .
Prozac . . . . . . . . . . . . . . . . . . . . . . .
Reclast . . . . . . . . . . . . . . . . . . . . . .
Restasis . . . . . . . . . . . . . . . . . . . . .
Seroquel . . . . . . . . . . . . . . . . . . . . .
1
2
3
4
5
Singulair . . . . . . . . . . . . . . . . . . . . .
Spiriva . . . . . . . . . . . . . . . . . . . . . . .
Stelara. . . . . . . . . . . . . . . . . . . . . . .
Symbicort . . . . . . . . . . . . . . . . . . . .
Tamiflu. . . . . . . . . . . . . . . . . . . . . . .
6
7
8
9
0
Used in last
12 months
15J-0
15T-0
Valtrex . . . . . . . . . . . . . . . . . . . . . . .
Vesicare . . . . . . . . . . . . . . . . . . . . .
Viagra . . . . . . . . . . . . . . . . . . . . . . .
Vytorin . . . . . . . . . . . . . . . . . . . . . . .
Wellbutrin . . . . . . . . . . . . . . . . . . . .
Xarelto . . . . . . . . . . . . . . . . . . . . . .
Xeljanz . . . . . . . . . . . . . . . . . . . . . .
Zetia . . . . . . . . . . . . . . . . . . . . . . . .
Zocor. . . . . . . . . . . . . . . . . . . . . . . .
Zoloft . . . . . . . . . . . . . . . . . . . . . . . .
Zostavax . . . . . . . . . . . . . . . . . . . . .
15H-0
1
2
3
4
5
6
1
2
3
4
5
6
7
8
9
0
X
Beyaz . . . . . . . . . . . . . . . . . . . . . .
Depo-Provera . . . . . . . . . . . . . . . .
Loestrin . . . . . . . . . . . . . . . . . . . .
Mirena . . . . . . . . . . . . . . . . . . . . .
Nexplanon . . . . . . . . . . . . . . . . . .
1
2
3
4
5
NuvaRing . . . . . . . . . . . . . . . . . . .
Ortho Tri-cyclen . . . . . . . . . . . . . .
Ortho Tri-cyclen Lo . . . . . . . . . . . .
Plan B One-Step . . . . . . . . . . . . .
Yaz . . . . . . . . . . . . . . . . . . . . . . . .
6
7
8
9
0
14R-0
IUD . . . . . . . . . . . . . . . . . . . . . . . .
Diaphragm or Cervical Cap . . . . .
OTHER (Write In)
1
2
3
Please indicate how much you AGREE or DISAGREE with each of the following statements by checking the box that comes closest
to how you feel.
15C
Agree
Strongly
Somewhat
Agree
Somewhat
Disagree
Disagree
Strongly
1
2
3
4
1.
2.
3.
4.
5.
I go to the doctor regularly for check-ups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I prefer alternative medicine to traditional medical practices . . . . . . . . . . . . . . . . . . . . . . . .
Generic medications are as effective as brand-name prescription drugs . . . . . . . . . . . . . .
In general, I feel I eat right . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
In general, I think herbal supplements are effective. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
01
02
03
04
05
6.
7.
8.
9.
10.
I take my prescription medicines exactly as prescribed . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I’m often first to try the most advanced medicines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I prefer popular brand-name drugs, even if they cost more . . . . . . . . . . . . . . . . . . . . . . . . .
I rely on my physician to recommend drug brands. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
In general, newer drug brands work better than older brands . . . . . . . . . . . . . . . . . . . . . . .
06
07
08
09
10
11.
12.
13.
14.
15.
If a drug brand works, I stick with it . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
To save money, I would buy prescription drugs from countries other than the United States.
Before I begin taking any drug, I look for as much information about it as possible. . . . . .
I am willing to take prescription drugs even if my insurance company doesn’t cover them. .
Over the counter medications are safer than prescription drugs. .. . . . . . . . . . . . . . . . . . . .
11
12
13
14
15
16.
17.
18.
19.
20.
I only go to the doctor when I’m very ill. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Sometimes I skip a dose of my prescription drugs because I worry about the side effects. .
I take medicine as soon as I don’t feel well. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Medication has improved the quality of my life. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I follow a regular exercise routine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16
17
18
19
20
21.
22.
23.
24.
25.
26.
My medical conditions limit my lifestyle somewhat. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I am always looking for new ways to live a healthier life. . . . . . . . . . . . . . . . . . . . . . . . . . .
I am happy with my weight. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I consult my pharmacist for health advice. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Vitamin supplements improve one’s health.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The benefits of vaccines outweigh any possible risks . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
21
22
23
24
25
26
CANDY
CANDY
(Regular or King Size)
Page 18
You Personally:
Individual
bars, boxes,
Bought
bags bought
last 6
last 7
days
months
CANDY
(Regular or King Size)
(Continued)
You Personally:
Individual
bars, boxes,
Bought
bags bought
last 6
last 7
days
months
129
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Regular Size. . . . . . . . . . . . .
King Size . . . . . . . . . . . . . . .
BRANDS:
AirHeads. . . . . . . . . . . . . . . .
AirHeads Bites . . . . . . . . . . .
AirHeads Xtremes . . . . . . . .
Almond Joy. . . . . . . . . . . . . .
Baby Ruth. . . . . . . . . . . . . . .
03
04
05
06
07
Bit-O-Honey . . . . . . . . . . . . .
Brach’s Peanut Clusters . . . .
Butterfinger. . . . . . . . . . . . . .
Cadbury Caramello . . . . . . .
Cadbury Creme Egg. . . . . . .
08
09
10
11
12
Cadbury Fruit and Nut . . . . .
Cadbury Milk Chocolate . . . .
Cadbury Roast Almond . . . .
Other Cadbury . . . . . . . . . . .
Charleston Chew . . . . . . . . .
13
14
15
16
17
Chunky . . . . . . . . . . . . . . . . .
Dove Chocolate . . . . . . . . . .
5th Avenue . . . . . . . . . . . . . .
Ghirardelli . . . . . . . . . . . . . . .
Goobers . . . . . . . . . . . . . . . .
18
19
20
21
22
Good & Plenty . . . . . . . . . . .
Green & Black’s . . . . . . . . . .
Haribo Gold-Bears . . . . . . . .
Heath . . . . . . . . . . . . . . . . . .
Hershey’s Air Delight . . . . . .
23
24
25
26
27
Hershey’s-Almond . . . . . . . .
Hershey’s Bliss . . . . . . . . . . .
Hershey’s Cookies ‘n’
Creme . . . . . . . . . . . . . . . .
Hershey’s Drops . . . . . . . . . .
Hershey’s Golden Almond . .
28
29
30
31
32
00
01
02
Raisinets . . . . . . . . . . . . . . .
Red Vines . . . . . . . . . . . . . . .
Reese’s Peanut Butter Cup. .
Reese’s Pieces. . . . . . . . . . .
Reese’s Sticks . . . . . . . . . . .
65
66
67
68
69
Reese’s Dark PB Cup. . . . . .
Reese’s White Choc. PB Cup
Rolo . . . . . . . . . . . . . . . . . . .
Russell Stover . . . . . . . . . . .
Skinny Cow . . . . . . . . . . . . .
70
71
72
73
74
Skittles . . . . . . . . . . . . . . . . .
Skor . . . . . . . . . . . . . . . . . . .
Snickers . . . . . . . . . . . . . . . .
Snickers Dark . . . . . . . . . . . .
Snickers Peanut Butter
Squared . . . . . . . . . . . . . .
75
76
77
78
79
Sno-Caps . . . . . . . . . . . . . . .
Starburst Fruit Chews. . . . . .
Sugar Babies . . . . . . . . . . . .
Sugar Daddy . . . . . . . . . . . .
Sweetarts . . . . . . . . . . . . . . .
80
81
82
83
84
Take 5 . . . . . . . . . . . . . . . . . .
3 Musketeers . . . . . . . . . . . .
Toblerone . . . . . . . . . . . . . . .
Tootsie Rolls . . . . . . . . . . . . .
Trolli . . . . . . . . . . . . . . . . . . .
Twix . . . . . . . . . . . . . . . . . . .
Twizzlers . . . . . . . . . . . . . . . .
Twizzlers Pull & Peel. . . . . . .
Twizzlers Sweet & Sour . . . .
Whatchamacallit . . . . . . . . . .
90
91
92
93
94
Whoppers . . . . . . . . . . . . . . . York Peppermint Pattie . . . . . Zero . . . . . . . . . . . . . . . . . . . 95
96
97
999
85
86
87
88
89
OTHER (Write In)
Hershey’s Kisses (Single
serving pack) . . . . . . . . . .
Hershey’s Kisses with
Almonds (Single serving
pack) . . . . . . . . . . . . . . . . .
Hershey’s Milk Chocolate . . .
Hershey’s Special Dark . . . .
Hershey’s Symphony . . . . . .
Junior Mints . . . . . . . . . . . . .
Kit Kat. . . . . . . . . . . . . . . . . .
Lancaster . . . . . . . . . . . . . . .
Life Savers Gummies . . . . . .
Lindt . . . . . . . . . . . . . . . . . . .
38
39
40
41
42
M & M’s Almond . . . . . . . . . .
M & M’s Dark Chocolate. . . .
M & M’s Dark Chocolate
Peanut . . . . . . . . . . . . . . .
M & M’s Milk Chocolate . . . .
M & M’s Mini’s . . . . . . . . . . .
43
44
45
46
47
M & M’s Peanut . . . . . . . . . .
M & M’s Peanut Butter . . . . .
M & M’s Pretzel. . . . . . . . . . .
Mike and Ike . . . . . . . . . . . . .
Milk Duds . . . . . . . . . . . . . . .
48
49
50
51
52
Milky Way . . . . . . . . . . . . . . .
Milky Way Midnight. . . . . . . .
Milky Way Simply Caramel . .
Mounds . . . . . . . . . . . . . . . .
Mr. Goodbar . . . . . . . . . . . . .
53
54
55
56
57
Nerds . . . . . . . . . . . . . . . . . .
Nestlé Crunch . . . . . . . . . . .
Nestlé Milk Chocolate. . . . . .
Now and Later . . . . . . . . . . .
100 Grand . . . . . . . . . . . . . .
58
59
60
61
62
PayDay . . . . . . . . . . . . . . . . . Peanut Chews . . . . . . . . . . . 63
64
33
HARD ROLL CANDY
34
35
36
37
You Personally:
Bought/
Rolls/
last 6
last 7
months
days
124
TOTAL:
................. BRANDS:
Creme Savers. . . . . . . . . . . .
Jolly Rancher . . . . . . . . . . . .
Life Savers . . . . . . . . . . . . . .
Mentos Mixed Fruit . . . . . . . .
Werther’s Original. . . . . . . . .
00
01
02
03
04
05
999
OTHER (Write In)
BOXED
CHOCOLATES
You Personally:
Bought
Boxes/
in last 6
last 30
months
days
127
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Fannie May. . . . . . . . . . . . . .
Ferrero Rocher . . . . . . . . . . .
Ghirardelli . . . . . . . . . . . . . . .
Godiva . . . . . . . . . . . . . . . . .
Hershey’s Pot of Gold. . . . . .
00
01
02
03
04
05
Lindt . . . . . . . . . . . . . . . . . . .
Russell Stover . . . . . . . . . . .
See’s. . . . . . . . . . . . . . . . . . .
Whitman’s . . . . . . . . . . . . . . .
06
07
08
09
999
OTHER (Write In)
How purchased:
128-0
Bought as gift . . . . . . . . . . . . 1
Bought for self . . . . . . . . . . . 2
PACKAGES OF
MINIATURE/LOOSE
CANDY
You Personally:
Bought
Packages
last 6
last 30
months
days
130
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
After Eight. . . . . . . . . . . . . . .
Almond Joy. . . . . . . . . . . . . .
Andes . . . . . . . . . . . . . . . . . .
Baby Ruth. . . . . . . . . . . . . . .
Brach’s Candy Corn. . . . . . . .
Brach’s Jelly Beans . . . . . . .
Brookside . . . . . . . . . . . . . . .
Butterfinger . . . . . . . . . . . . . .
Cadbury Mini Eggs . . . . . . . .
Dove Promises Chocolate . .
Haribo Gold-Bears . . . . . . . .
Hershey’s-Almond . . . . . . . .
Hershey’s Bliss . . . . . . . . . . .
Hershey’s Drops . . . . . . . . . .
Hershey’s Hugs . . . . . . . . . .
Hershey’s Kisses . . . . . . . . .
Hershey’s Kisses with
Almonds . . . . . . . . . . . . . .
Hershey’s Krackel. . . . . . . . .
Hershey’s Milk Chocolate . . .
Hershey’s Miniatures . . . . . .
Hershey’s Nuggets . . . . . . . .
Hershey’s Pieces . . . . . . . . .
Jelly Belly beans. . . . . . . . . .
Jolly Rancher Chews . . . . . .
Jolly Rancher Gummies . . . .
Jolly Rancher Hard Candy . .
Kraft Caramels . . . . . . . . . . .
Life Savers . . . . . . . . . . . . . .
Life Savers Gummies . . . . . .
Lindt Lindor Truffles . . . . . . .
M & M’s Almond . . . . . . . . . .
M & M’s Milk Chocolate . . . .
M & M’s Peanut . . . . . . . . . .
M & M’s Peanut Butter . . . . .
Milk Duds . . . . . . . . . . . . . . .
Milky Way . . . . . . . . . . . . . . .
Mounds . . . . . . . . . . . . . . . .
Mr. Goodbar . . . . . . . . . . . . .
Nestlé Crunch . . . . . . . . . . .
Raisinets . . . . . . . . . . . . . . .
Reese’s Peanut Butter Cup. .
Reese’s Pieces. . . . . . . . . . .
Riesen . . . . . . . . . . . . . . . . .
Rolo . . . . . . . . . . . . . . . . . . .
Skittles . . . . . . . . . . . . . . . . .
Snickers . . . . . . . . . . . . . . . .
Sour Patch Kids . . . . . . . . . .
Starburst Fruit Chews. . . . . .
Starburst Jellybeans . . . . . . .
Swedish Fish . . . . . . . . . . . .
3 Musketeers . . . . . . . . . . . .
Tootsie Rolls . . . . . . . . . . . . .
Twix . . . . . . . . . . . . . . . . . . .
Twizzlers . . . . . . . . . . . . . . . .
Werther’s Original. . . . . . . . .
Whoppers . . . . . . . . . . . . . . . York Peppermint Pattie . . . . . OTHER (Write In)
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
999
ARTIFICIAL SWEETENERS, GUM/SNACKS & BEVERAGES
Page 19
MINTS
You Personally:
Bought/
Packages/
last 6
last 7
months
days
ARTIFICIAL &
LO-CAL
SWEETENERS
121
TOTAL:
You Personally:
Used in
Times/
last 6
last 7
months
days
122
................. TYPES:
Sugarless . . . . . . . . . . . . . . . Regular. . . . . . . . . . . . . . . . . BRANDS:
Altoids. . . . . . . . . . . . . . . . . .
Breath Savers. . . . . . . . . . . .
Certs. . . . . . . . . . . . . . . . . . .
Eclipse Mints . . . . . . . . . . . .
Ice Breakers . . . . . . . . . . . . .
Life Savers . . . . . . . . . . . . . . Mentos Mint . . . . . . . . . . . . . Tic Tac Mint. . . . . . . . . . . . . . 00
01
02
03
04
05
06
07
08
09
10
999
TOTAL:
You Personally:
Chewed
Sticks/
in last 6
pieces last
months
7 days
01
02
03
BRANDS:
Domino Light . . . . . . . . . . . .
Equal . . . . . . . . . . . . . . . . . .
Monk Fruit in the Raw . . . . .
NutraSweet . . . . . . . . . . . . .
PureVia . . . . . . . . . . . . . . . .
04
05
06
07
08
09
10
11
12
999
Splenda . . . . . . . . . . . . . . . .
Stevia in the Raw . . . . . . . . .
Sweet ’n Low . . . . . . . . . . . .
Truvia . . . . . . . . . . . . . . . . . .
OTHER (Write In)
123
TOTAL:
................. BRANDS:
Bazooka . . . . . . . . . . . . . . . .
Bubble Yum . . . . . . . . . . . . .
Bubblicious . . . . . . . . . . . . . .
Chiclets . . . . . . . . . . . . . . . .
Dentyne Ice. . . . . . . . . . . . . .
Dentyne Pure. . . . . . . . . . . . .
Dubble Bubble . . . . . . . . . . .
5 Gum . . . . . . . . . . . . . . . . .
Hubba Bubba . . . . . . . . . . . .
Ice Breakers . . . . . . . . . . . . .
Mentos Gum. . . . . . . . . . . . .
Mentos UP2U . . . . . . . . . . . .
Stride . . . . . . . . . . . . . . . . . .
Stride iD . . . . . . . . . . . . . . . .
Trident Bubble Gum . . . . . . .
Trident Layers . . . . . . . . . . .
Trident Splash. . . . . . . . . . . .
Trident Sugarless . . . . . . . . .
Trident White. . . . . . . . . . . . .
Trident Xtra Care . . . . . . . . .
Wrigley’s Big Red . . . . . . . . .
Wrigley’s Doublemint . . . . . .
Wrigley’s Eclipse. . . . . . . . . .
Wrigley’s Extra . . . . . . . . . . .
Wrigley’s Extra Dessert
Delights. . . . . . . . . . . . . . .
Wrigley’s Juicy Fruit . . . . . . .
Wrigley’s Orbit . . . . . . . . . . .
Wrigley’s Orbit White. . . . . . .
Wrigley’s Spearmint . . . . . . .
Wrigley’s Winterfresh . . . . . .
OTHER (Write In)
SNACK MIXES
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
999
................. BRANDS:
Cheerios Snack Mix . . . . . . .
Cheez-It Snack Mix . . . . . . .
Chex Mix . . . . . . . . . . . . . . .
Gardetto’s . . . . . . . . . . . . . . .
Planters NUT-rition Mix. . . . .
Planters Trail Mix . . . . . . . . . Ritz Snack Mix . . . . . . . . . . . OTHER (Write In)
00
TYPES:
Dry-roasted. . . . . . . . . . . . . . Honey Roasted. . . . . . . . . . . Regular. . . . . . . . . . . . . . . . . 01
02
03
FORMS:
Salted . . . . . . . . . . . . . . . . . . Unsalted . . . . . . . . . . . . . . . . KINDS:
Almonds (Smoked) . . . . . . . .
Almonds (Other Types). . . . .
Cashews. . . . . . . . . . . . . . . .
Hazelnuts . . . . . . . . . . . . . . .
Macadamia. . . . . . . . . . . . . .
Mixed Nuts . . . . . . . . . . . . . .
Peanuts . . . . . . . . . . . . . . . .
Pecans . . . . . . . . . . . . . . . . .
Pistachios. . . . . . . . . . . . . . .
Sunflower Seeds . . . . . . . . .
Walnuts. . . . . . . . . . . . . . . . .
BRANDS:
Blue Diamond. . . . . . . . . . . .
David . . . . . . . . . . . . . . . . . .
Diamond. . . . . . . . . . . . . . . .
Emerald . . . . . . . . . . . . . . . .
Fisher . . . . . . . . . . . . . . . . . .
Frito-Lay . . . . . . . . . . . . . . . .
Mauna Loa . . . . . . . . . . . . . .
Planters . . . . . . . . . . . . . . . .
Wonderful . . . . . . . . . . . . . . .
OTHER (Write In)
READY TO DRINK
ICED TEA
You Personally:
Bought
Boxes/
in last 6
last 30
months
days
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
999
You Personally:
Drank in
Drinks or
last 6
glasses/
months
last 7 days
136
................. 00
TYPES:
Flavored . . . . . . . . . . . . . . . . Unflavored . . . . . . . . . . . . . . 01
02
TOTAL:
126
TOTAL:
................. TOTAL:
06
07
08
09
10
You Personally:
Bought
Containers/
in last 6
last 30
months
days
00
01
02
03
04
05
06
07
999
TOTAL:
................. BRANDS:
Atkins Advantage . . . . . . . . .
Balance Bar . . . . . . . . . . . . .
Clif Bar . . . . . . . . . . . . . . . . .
Glucerna Bar . . . . . . . . . . . .
KIND. . . . . . . . . . . . . . . . . . .
Lärabar. . . . . . . . . . . . . . . . .
Luna Bar. . . . . . . . . . . . . . . .
Met Rx Bar . . . . . . . . . . . . . .
Planters Sustaining Energy .
PowerBar . . . . . . . . . . . . . . .
Pure Protein . . . . . . . . . . . . .
Slim-Fast Bar . . . . . . . . . . . .
South Beach Diet . . . . . . . . .
Supreme Protein. . . . . . . . . .
ThinkThin . . . . . . . . . . . . . . .
ZonePerfect Bar . . . . . . . . . . 00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
999
OTHER (Write In)
125
00
01
02
03
04
05
00
TYPES:
Tablets . . . . . . . . . . . . . . . . . Packets. . . . . . . . . . . . . . . . . Loose Powder. . . . . . . . . . . . NUTS
You Personally:
Used in
Bars/
last 6
last 30
months
days
15V
................. OTHER (Write In)
CHEWING GUM
NUTRITION/
ENERGY BARS
BRANDS:
Arizona . . . . . . . . . . . . . . . . .
Brisk . . . . . . . . . . . . . . . . . . .
Fuze . . . . . . . . . . . . . . . . . . .
Gold Peak. . . . . . . . . . . . . . .
Honest Tea . . . . . . . . . . . . . .
Lipton’s Iced Tea . . . . . . . . . .
Nestea . . . . . . . . . . . . . . . . .
Pure Leaf . . . . . . . . . . . . . . .
Snapple . . . . . . . . . . . . . . . .
Turkey Hill . . . . . . . . . . . . . . .
OTHER (Write In)
03
04
05
06
07
08
09
10
11
12
999
BOTTLED WATER &
SELTZER
You Personally:
Drank
Drinks or
in last 6
glasses/
months
last 7 days
138
................. 00
TYPES:
Flavored . . . . . . . . . . . . . . . . Non-Flavored . . . . . . . . . . . . 01
02
KINDS:
Non-Sparkling . . . . . . . . . . . Sparkling . . . . . . . . . . . . . . . 03
04
FORMS:
Sweetened . . . . . . . . . . . . . . Unsweetened . . . . . . . . . . . . 05
06
TOTAL:
BRANDS:
Aquafina . . . . . . . . . . . . . . . .
Aquafina Flavorsplash . . . . .
Arrowhead . . . . . . . . . . . . . .
Canada Dry Seltzer . . . . . . .
Capri Sun Roarin’ Waters . . .
Crystal Geyser . . . . . . . . . . .
Crystal Springs. . . . . . . . . . .
Dasani . . . . . . . . . . . . . . . . .
Deer Park . . . . . . . . . . . . . . .
Deja Blue . . . . . . . . . . . . . . .
Evian . . . . . . . . . . . . . . . . . .
Fiji. . . . . . . . . . . . . . . . . . . . .
Fruit2O . . . . . . . . . . . . . . . . .
Ice Mountain. . . . . . . . . . . . .
Icelandic Glacial . . . . . . . . . .
La Croix . . . . . . . . . . . . . . . .
Mountain Valley . . . . . . . . . .
Nestlé Pure Life . . . . . . . . . .
Niagara. . . . . . . . . . . . . . . . .
Ozarka . . . . . . . . . . . . . . . . .
Perrier . . . . . . . . . . . . . . . . .
Poland Spring. . . . . . . . . . . .
Propel . . . . . . . . . . . . . . . . . .
S.Pellegrino . . . . . . . . . . . . .
Schweppes Seltzer. . . . . . . .
Seagram’s Seltzer . . . . . . . .
Smartwater (Glacéau) . . . . .
SoBe Lifewater . . . . . . . . . . .
Sparkletts . . . . . . . . . . . . . . .
Vintage Seltzer . . . . . . . . . . .
Vitamin Water (Glacéau) . . .
Zephyrhills . . . . . . . . . . . . . .
OTHER (Write In)
Do you receive home delivery of bottled
139-0
water? Yes 1
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
999
BEVERAGES
DIET COLA DRINKS
Page 20
You Personally:
Drank in
Drinks or
last 6
glasses/
months
last 7 days
OTHER DIET SOFT
DRINKS, NOT COLAS
133
TOTAL:
00
KINDS:
Plastic Bottles. . . . . . . . . . . . Glass Bottles . . . . . . . . . . . . Cans . . . . . . . . . . . . . . . . . . . BRANDS:
Caffeine Free Diet Coke . . . .
Coca-Cola Zero . . . . . . . . . .
Coca-Cola Cherry Zero . . . .
Diet Cherry Coke . . . . . . . . .
Diet Coke . . . . . . . . . . . . . . .
Diet Coke w/Lime . . . . . . . . .
Diet Rite Cola . . . . . . . . . . . .
Caffeine Free Diet Pepsi. . . .
Diet Pepsi . . . . . . . . . . . . . . .
Pepsi Max. . . . . . . . . . . . . . .
Pepsi Next . . . . . . . . . . . . . . Diet Wild Cherry Pepsi . . . . . Store’s Own Brand . . . . . . . . 01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
999
OTHER (Write In)
You Personally:
Drank in
Drinks or
last 6
glasses/
months
last 7 days
134
TOTAL:
................. 00
KINDS:
Caffeine Free Coca-Cola . . .
Cherry Coke . . . . . . . . . . . . .
Coca-Cola Classic . . . . . . . .
Pepsi-Cola . . . . . . . . . . . . . .
Pepsi Real Sugar . . . . . . . . .
Caffeine Free Pepsi . . . . . . .
Wild Cherry Pepsi. . . . . . . . .
RC Cola . . . . . . . . . . . . . . . .
OTHER (Write In)
ENERGY DRINKS
SIZE:
Shot . . . . . . . . . . . . . . . . . . . Regular. . . . . . . . . . . . . . . . . BRANDS:
AMP . . . . . . . . . . . . . . . . . . .
5-hour Energy. . . . . . . . . . . .
Full Throttle. . . . . . . . . . . . . .
Monster . . . . . . . . . . . . . . . .
NOS . . . . . . . . . . . . . . . . . . .
Red Bull . . . . . . . . . . . . . . . . Rockstar . . . . . . . . . . . . . . . . SK Energy . . . . . . . . . . . . . . OTHER (Write In)
BRANDS:
Diet A & W Root Beer. . . . . .
Diet Barq’s Root Beer. . . . . .
Canada Dry Diet Ginger Ale
Diet Dr Pepper . . . . . . . . . . .
Diet Dr Pepper Cherry . . . . .
Dr Pepper TEN . . . . . . . . . . .
Fanta Zero . . . . . . . . . . . . . .
Fresca . . . . . . . . . . . . . . . . .
Diet Mountain Dew . . . . . . . .
Diet Mug Root Beer . . . . . . .
Diet 7 Up . . . . . . . . . . . . . . .
Diet Cherry 7 Up . . . . . . . . .
7 Up TEN . . . . . . . . . . . . . . .
Diet Sierra Mist. . . . . . . . . . .
Sprite Zero . . . . . . . . . . . . . .
Diet Squirt . . . . . . . . . . . . . . Diet Sunkist Orange . . . . . . . 03
04
05
06
07
08
09
10
11
12
999
00
01
02
03
04
05
06
07
08
09
10
999
00
01
02
03
04
05
06
07
08
09
10
13
14
15
16
17
18
19
20
999
You Personally:
Drank in
Drinks or
last 6
glasses/
months
last 7 days
................. KINDS:
A & W Root Beer . . . . . . . . .
Barq’s Root Beer . . . . . . . . .
Canada Dry Club Soda . . . .
Canada Dry Ginger Ale . . . .
Other Canada Dry . . . . . . . .
Crush-Orange . . . . . . . . . . .
Dad’s Root Beer . . . . . . . . . .
Dr Pepper . . . . . . . . . . . . . . .
Dr Pepper Cherry . . . . . . . . .
Fanta . . . . . . . . . . . . . . . . . .
Faygo . . . . . . . . . . . . . . . . . .
Hires Root Beer . . . . . . . . . .
IBC Root Beer . . . . . . . . . . .
Mello Yello . . . . . . . . . . . . . .
Mountain Dew . . . . . . . . . . .
Mountain Dew Baja Blast . . .
Mountain Dew Code Red . . .
Mountain Dew Kickstart . . . .
Mug Root Beer . . . . . . . . . . .
Pibb Xtra. . . . . . . . . . . . . . . .
Seagram’s Ginger Ale . . . . .
7 Up . . . . . . . . . . . . . . . . . . .
Cherry 7 Up . . . . . . . . . . . . .
Schweppes Club Soda. . . . .
Schweppes Ginger Ale. . . . .
Schweppes Tonic . . . . . . . . .
Shasta . . . . . . . . . . . . . . . . .
Sierra Mist . . . . . . . . . . . . . .
Sprite . . . . . . . . . . . . . . . . . .
Squirt . . . . . . . . . . . . . . . . . .
Sun Drop . . . . . . . . . . . . . . .
Sunkist . . . . . . . . . . . . . . . . .
Vernors . . . . . . . . . . . . . . . . .
Welch’s Grape Soda . . . . . . .
OTHER (Write In)
................. BRANDS:
All Sport . . . . . . . . . . . . . . . .
Gatorade G Series . . . . . . . .
Gatorade Endurance . . . . . .
Gatorade G2. . . . . . . . . . . . .
Powerade . . . . . . . . . . . . . . .
00
01
04
00
01
02
03
04
05
06
999
OTHER (Write In)
PREPARED
MIXED DRINKS
WITH LIQUOR
You Personally:
Drank in
Drinks or
last 6
glasses/
months
last 30 days
156
TOTAL:
................. BRANDS:
Arbor Mist . . . . . . . . . . . . . . .
Bacardi Party Drinks . . . . . .
Chi Chi’s Margaritas . . . . . . .
Daily’s Cocktails . . . . . . . . . .
José Cuervo Authentic
Margaritas. . . . . . . . . . . . .
José Cuervo Golden
Margarita. . . . . . . . . . . . . .
Kahlúa White Russian . . . . .
Other Kahlúa . . . . . . . . . . . .
Parrot Bay. . . . . . . . . . . . . . .
Skinnygirl . . . . . . . . . . . . . . .
Smirnoff Cocktails . . . . . . . . TGI Friday’s . . . . . . . . . . . . . 00
01
02
03
04
05
06
07
08
09
10
11
12
999
OTHER (Write In)
02
03
Powerade Zero . . . . . . . . . . . 11
140
TOTAL:
TOTAL:
12
OTHER (Write In)
02
You Personally:
Drank in
Drinks/
last 6
last 30
months
days
................. ................. OTHER REGULAR
CARBONATED SOFT
DRINKS
You Personally:
Drank in
Drinks/
last 6
last 30
months
days
135
KINDS:
Plastic Bottles. . . . . . . . . . . . Glass Bottles . . . . . . . . . . . . Cans . . . . . . . . . . . . . . . . . . . 01
TOTAL:
(Not seltzer, colas or diet)
143
TOTAL:
SPORTS DRINKS/
THIRST QUENCHERS
137
................. REGULAR COLA
DRINKS, NOT DIET
You Personally:
Drank
Drinks or
in last 6
glasses/
months
last 7 days
PREPARED
MIXED DRINKS
WITHOUT LIQUOR
05
You Personally:
Drank in
Drinks or
last 6
glasses/
months
last 30 days
157
06
07
TOTAL:
................. 00
08
TYPES:
Frozen Concentrate . . . . . . . Liquid . . . . . . . . . . . . . . . . . . 02
09
10
11
12
13
14
15
BRANDS:
Daily’s Mixers . . . . . . . . . . . .
Bacardi Mixers . . . . . . . . . . .
José Cuervo Margarita Mix .
Mr. & Mrs. T . . . . . . . . . . . . .
16
17
OTHER (Write In)
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
FLAVORED
ALCOHOLIC
BEVERAGES/COOLERS
37
03
04
05
06
999
You Personally:
Drank in
Drinks or
last 6
glasses/
months
last 30 days
148
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Bartles & Jaymes. . . . . . . . . .
Bud Light Lime-A-Rita . . . . . .
Bud Light Straw-Ber-Rita . . . .
Four Loko . . . . . . . . . . . . . . .
Mike’s Hard Lemonade. . . . .
Seagram’s Escapes . . . . . . .
Smirnoff Ice . . . . . . . . . . . . .
Smirnoff Ice Triple Black . . . .
Twisted Tea . . . . . . . . . . . . . .
ULTRA 19th Hole . . . . . . . . .
36
999
01
OTHER (Write In)
00
01
02
03
04
05
06
07
08
09
10
999
BEVERAGES
Page 21
REGULAR DOMESTIC
BEER/ALE
You Personally:
Drank in
Glasses/
last 6
last 7
months
days
IMPORTED
BEER/ALE
142
00
01
02
03
04
05
06
07
08
Busch . . . . . . . . . . . . . . . . . .
Coors . . . . . . . . . . . . . . . . . .
Genesee Beer . . . . . . . . . . .
George Killian’s Irish Red . . .
Goose Island . . . . . . . . . . . .
09
10
11
12
13
Icehouse. . . . . . . . . . . . . . . .
Keystone. . . . . . . . . . . . . . . .
Landshark Lager . . . . . . . . .
Leinenkugel’s . . . . . . . . . . . .
Michelob. . . . . . . . . . . . . . . .
14
15
16
17
18
Michelob AmberBock . . . . . .
Miller Fortune . . . . . . . . . . . .
Miller Genuine Draft . . . . . . .
Miller High Life . . . . . . . . . . .
Milwaukee’s Best . . . . . . . . .
Natural Ice . . . . . . . . . . . . . .
New Belgium . . . . . . . . . . . .
Pabst Blue Ribbon . . . . . . . .
Redd’s Apple Ale . . . . . . . . .
Redhook . . . . . . . . . . . . . . . .
Rolling Rock . . . . . . . . . . . . .
Samuel Adams . . . . . . . . . . .
Shiner Bock . . . . . . . . . . . . .
Shock Top. . . . . . . . . . . . . . .
Sierra Nevada . . . . . . . . . . .
Yuengling . . . . . . . . . . . . . . .
Other Small/Regional Brand
OTHER (Write In)
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
999
You Personally:
Drank in
Glasses/
last 6
last 7
months
days
................. KINDS:
Bottles . . . . . . . . . . . . . . . . .
Cans . . . . . . . . . . . . . . . . . . .
Draft . . . . . . . . . . . . . . . . . . .
BRANDS:
Bud Light . . . . . . . . . . . . . . .
Bud Light Lime . . . . . . . . . . .
Bud Light Platinum . . . . . . . .
Busch Light . . . . . . . . . . . . .
Coors Light . . . . . . . . . . . . . .
Keystone Light . . . . . . . . . . .
Michelob Light . . . . . . . . . . .
Michelob ULTRA . . . . . . . . .
Miller64. . . . . . . . . . . . . . . . .
Miller High Life Light. . . . . . .
Miller Lite . . . . . . . . . . . . . . .
Milwaukee’s Best Light . . . . .
Natural Light. . . . . . . . . . . . .
Sam Adams Light . . . . . . . . .
Select . . . . . . . . . . . . . . . . . .
Select 55 . . . . . . . . . . . . . . .
Yuengling Light . . . . . . . . . . .
OTHER (Write In)
147
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
999
Sauvignon Blanc . . . . . . . . .
Other Red. . . . . . . . . . . . . . .
Other White . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . .
BRANDS:
Almaden . . . . . . . . . . . . . . . .
Apothic . . . . . . . . . . . . . . . . .
Arbor Mist . . . . . . . . . . . . . . .
Barefoot . . . . . . . . . . . . . . . .
Beaulieu Vineyard (BV) . . . .
16
17
18
19
20
Beringer . . . . . . . . . . . . . . . .
Black Box . . . . . . . . . . . . . . .
Blackstone . . . . . . . . . . . . . .
Bogle . . . . . . . . . . . . . . . . . .
Carlo Rossi. . . . . . . . . . . . . .
21
22
23
24
25
Molson Canadian . . . . . . . . .
Montejo. . . . . . . . . . . . . . . . .
Moosehead . . . . . . . . . . . . .
Negra Modelo. . . . . . . . . . . .
Newcastle Brown . . . . . . . . .
26
27
28
29
30
Chateau Ste. Michelle . . . . .
Charles Shaw. . . . . . . . . . . .
Clos Du Bois. . . . . . . . . . . . .
Columbia Crest. . . . . . . . . . .
Concannon . . . . . . . . . . . . . .
Pacifico. . . . . . . . . . . . . . . . .
Peroni . . . . . . . . . . . . . . . . . .
Pilsner Urquell . . . . . . . . . . .
Presidente . . . . . . . . . . . . . .
Red Stripe . . . . . . . . . . . . . .
31
32
33
34
35
Corbett Canyon . . . . . . . . . .
Crane Lake. . . . . . . . . . . . . .
Cupcake Vineyards. . . . . . . .
Fetzer . . . . . . . . . . . . . . . . . .
Francis Coppola . . . . . . . . . .
Smithwick’s. . . . . . . . . . . . . .
St. Pauli Girl . . . . . . . . . . . . .
Stella Artois . . . . . . . . . . . . .
Tecate . . . . . . . . . . . . . . . . . .
Tsingtao . . . . . . . . . . . . . . . .
36
37
38
39
40
999
Franzia . . . . . . . . . . . . . . . . .
Gallo. . . . . . . . . . . . . . . . . . .
Gallo of Sonoma . . . . . . . . .
Gnarly Head . . . . . . . . . . . . .
Inglenook . . . . . . . . . . . . . . .
Josh Cellars . . . . . . . . . . . . .
Kendall-Jackson . . . . . . . . . .
Kenwood Vineyards . . . . . . .
Layer Cake . . . . . . . . . . . . . .
Livingston Cellars . . . . . . . . .
Manischewitz . . . . . . . . . . . .
Ménage à Trois . . . . . . . . . . .
Mirassou. . . . . . . . . . . . . . . .
Mogen David . . . . . . . . . . . .
Oak Leaf. . . . . . . . . . . . . . . .
Ravenswood. . . . . . . . . . . . .
Redwood Creek . . . . . . . . . .
Rex-Goliath. . . . . . . . . . . . . .
Robert Mondavi . . . . . . . . . .
Rodney Strong . . . . . . . . . . .
Seven Daughters . . . . . . . . .
Skinnygirl . . . . . . . . . . . . . . .
Smoking Loon . . . . . . . . . . .
Sterling Vineyards . . . . . . . .
Sutter Home . . . . . . . . . . . . .
Toasted Head . . . . . . . . . . . .
Turning Leaf . . . . . . . . . . . . .
Vendange . . . . . . . . . . . . . . .
Wild Vines. . . . . . . . . . . . . . .
Woodbridge . . . . . . . . . . . . .
00
01
02
03
04
05
06
07
08
09
10
Corona Extra . . . . . . . . . . . .
Corona Light. . . . . . . . . . . . .
Dos Equis. . . . . . . . . . . . . . .
Foster’s. . . . . . . . . . . . . . . . .
Grolsch . . . . . . . . . . . . . . . . .
11
12
13
14
15
Guinness Draught . . . . . . . .
Guinness Stout. . . . . . . . . . .
Harp . . . . . . . . . . . . . . . . . . .
Heineken . . . . . . . . . . . . . . .
Heineken Light . . . . . . . . . . .
Hoegaarden . . . . . . . . . . . . .
Kirin . . . . . . . . . . . . . . . . . . .
Labatt Blue . . . . . . . . . . . . . .
Leffe . . . . . . . . . . . . . . . . . . .
Modelo Especial . . . . . . . . . .
OTHER (Write In)
00
You Personally:
Drank in
Drinks or
last 6
glasses/
months
last 7 days
TOTAL: . . . . . . . . . . . . . . . . .
KINDS:
Cabernet Sauvignon . . . . . . .
Chardonnay . . . . . . . . . . . . .
Merlot . . . . . . . . . . . . . . . . . .
Pinot Grigio . . . . . . . . . . . . . .
Pinot Noir . . . . . . . . . . . . . . .
TOTAL: . . . . . . . . . . . . . . . . .
KINDS:
Bottles . . . . . . . . . . . . . . . . .
Cans . . . . . . . . . . . . . . . . . . .
Draft . . . . . . . . . . . . . . . . . . .
TYPES:
Lager (light color) . . . . . . . . .
Dark . . . . . . . . . . . . . . . . . . .
BRANDS:
Amstel Light . . . . . . . . . . . . .
Bass . . . . . . . . . . . . . . . . . . .
Becks . . . . . . . . . . . . . . . . . .
Becks Dark . . . . . . . . . . . . . .
Becks Sapphire . . . . . . . . . .
141
TOTAL:
DOMESTIC DINNER/
TABLE WINES
144
TOTAL: . . . . . . . . . . . . . . . . .
KINDS:
Bottles . . . . . . . . . . . . . . . . .
Cans . . . . . . . . . . . . . . . . . . .
Draft . . . . . . . . . . . . . . . . . . .
BRANDS:
Anchor Steam. . . . . . . . . . . .
Blue Moon . . . . . . . . . . . . . .
Budweiser . . . . . . . . . . . . . .
Budweiser Black Crown . . . .
Bud Ice . . . . . . . . . . . . . . . . .
LOW CALORIE
DOMESTIC BEER
You Personally:
Drank in
Glasses/
last 6
last 7
months
days
HARD CIDER
You Personally:
Drank in
Drinks or
last 6
glasses/
months
last 30 days
146
00
01
02
03
04
05
Stella Artois Cidre. . . . . . . . . Strongbow . . . . . . . . . . . . . . Woodchuck. . . . . . . . . . . . . . 06
07
08
999
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Angry Orchard . . . . . . . . . . .
Crispin . . . . . . . . . . . . . . . . .
Johnny Appleseed . . . . . . . .
Michelob ULTRA Light Cider
Smith & Forge . . . . . . . . . . .
OTHER (Write In)
MALT LIQUOR
You Personally:
Drank in
Glasses/
last 6
last 30
months
days
149
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Colt 45 . . . . . . . . . . . . . . . . .
King Cobra . . . . . . . . . . . . . .
Mickey’s . . . . . . . . . . . . . . . .
Olde English 800 . . . . . . . . .
OTHER (Write In)
00
01
02
03
04
999
OTHER (Write In)
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
999
BEVERAGES
IMPORTED DINNER/
TABLE WINES
Page 22
You Personally:
Drank in
Drinks or
last 6
glasses/
months
last 7 days
PORT, SHERRY &
DESSERT WINES
150
TOTAL:
KINDS:
Australian Red . . . . . . . . . . .
Australian White . . . . . . . . . .
French Red. . . . . . . . . . . . . .
French White . . . . . . . . . . . .
German White . . . . . . . . . . .
Italian Red . . . . . . . . . . . . . .
Italian White . . . . . . . . . . . . .
South American Red . . . . . .
South American White . . . . .
Spanish Red. . . . . . . . . . . . .
Spanish White . . . . . . . . . . . Other . . . . . . . . . . . . . . . . . . BRANDS:
Bella Sera. . . . . . . . . . . . . . .
Black Swan. . . . . . . . . . . . . .
Bolla . . . . . . . . . . . . . . . . . . .
Cavit . . . . . . . . . . . . . . . . . . .
Concha y Toro . . . . . . . . . . .
Ecco Domani . . . . . . . . . . . .
FishEye . . . . . . . . . . . . . . . .
George DuBoeuf . . . . . . . . .
Jacob’s Creek. . . . . . . . . . . .
Kim Crawford . . . . . . . . . . . .
Lindemans . . . . . . . . . . . . . .
The Little Penguin. . . . . . . . .
Luna di Luna . . . . . . . . . . . .
Mouton Cadet. . . . . . . . . . . .
Real Sangria. . . . . . . . . . . . .
Riunite . . . . . . . . . . . . . . . . .
Rosemount Estate . . . . . . . .
Ruffino . . . . . . . . . . . . . . . . .
Santa Margherita . . . . . . . . .
Santa Rita. . . . . . . . . . . . . . .
Yellow Tail . . . . . . . . . . . . . . . 00
01
02
03
04
05
06
07
09
11
12
BRANDS:
Andre . . . . . . . . . . . . . . . . . .
Ballatore . . . . . . . . . . . . . . . .
Barefoot Bubbly . . . . . . . . . .
Chandon. . . . . . . . . . . . . . . .
Cook’s . . . . . . . . . . . . . . . . .
Dom Perignon . . . . . . . . . . .
Freixenet. . . . . . . . . . . . . . . .
Korbel . . . . . . . . . . . . . . . . . .
Martini & Rossi . . . . . . . . . . .
Mionetto . . . . . . . . . . . . . . . .
Moët & Chandon . . . . . . . . .
Perrier-Jouët. . . . . . . . . . . . .
Verdi Spumante . . . . . . . . . .
Veuve Clicquot . . . . . . . . . . .
Yellow Tail . . . . . . . . . . . . . . .
OTHER (Write In)
BRANDS:
Christian Brothers. . . . . . . . .
Gallo. . . . . . . . . . . . . . . . . . .
Harvey’s Bristol Cream. . . . .
Taylor’s . . . . . . . . . . . . . . . . .
OTHER (Write In)
CORDIALS &
LIQUEURS
00
01
02
03
04
05
06
999
You Personally:
Drank in
Drinks or
last 6
glasses/
months
last 30 days
154
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
999
151
KINDS:
Asti Spumanti . . . . . . . . . . . .
Cava . . . . . . . . . . . . . . . . . . .
Champagne . . . . . . . . . . . . .
Prosecco. . . . . . . . . . . . . . . .
Other Sparkling Wines . . . . .
................. TYPES:
Dry . . . . . . . . . . . . . . . . . . . . Sweet . . . . . . . . . . . . . . . . . . 10
You Personally:
Drank in
Drinks or
last 6
glasses/
months
last 30 days
................. TOTAL:
00
01
02
03
04
05
06
07
08
09
10
TOTAL: . . . . . . . . . . . . . . . . . 00
KINDS:
Amaretto . . . . . . . . . . . . . . . .
Anisette. . . . . . . . . . . . . . . . .
Blackberry . . . . . . . . . . . . . .
Coffee . . . . . . . . . . . . . . . . . .
Creme de Cacao . . . . . . . . .
01
02
03
04
05
Creme de Menthe. . . . . . . . .
Hazelnut . . . . . . . . . . . . . . . .
Irish Cream. . . . . . . . . . . . . .
Melon . . . . . . . . . . . . . . . . . .
Sambuca . . . . . . . . . . . . . . .
06
07
08
09
10
Peach Schnapps . . . . . . . . .
Peppermint Schnapps . . . . .
Other Schnapps . . . . . . . . . .
Triple Sec/Orange. . . . . . . . .
Other . . . . . . . . . . . . . . . . . .
11
12
13
14
16
17
18
19
20
Cointreau . . . . . . . . . . . . . . .
DeKuyper . . . . . . . . . . . . . . .
DiSaronno Originale . . . . . .
Drambuie . . . . . . . . . . . . . . .
Frangelico. . . . . . . . . . . . . . .
21
22
23
24
25
Godiva . . . . . . . . . . . . . . . . .
Goldschläger . . . . . . . . . . . .
Grand Marnier . . . . . . . . . . .
Jack Daniel’s Tennessee
Honey . . . . . . . . . . . . . . . .
Jägermeister . . . . . . . . . . . .
26
27
28
29
30
Kahlúa Original. . . . . . . . . . .
Kahlúa Flavors . . . . . . . . . . .
Midori . . . . . . . . . . . . . . . . . .
Patrón XO Cafe . . . . . . . . . .
Romana Sambuca . . . . . . . .
31
32
33
34
35
Southern Comfort. . . . . . . . . Tequila Rose. . . . . . . . . . . . . Wild Turkey American Honey 36
37
38
999
OTHER (Write In)
VERMOUTH
14
15
16
17
18
19
20
999
You Personally:
Drank in
Drinks or
last 6
glasses/
months
last 30 days
152
................. 00
BRANDS:
Martini & Rossi . . . . . . . . . . . Stock . . . . . . . . . . . . . . . . . . 01
02
999
TOTAL:
00
01
02
MIXED DRINK TYPES:
Apple Martini . . . . . . . . . . . .
Bloody Mary . . . . . . . . . . . . .
Cosmopolitan . . . . . . . . . . . .
Daiquiri. . . . . . . . . . . . . . . . .
Gin & Tonic . . . . . . . . . . . . . .
Gin Martini . . . . . . . . . . . . . .
Jack & Coke . . . . . . . . . . . . .
Lemon Drop . . . . . . . . . . . . .
Long Island Iced Tea . . . . . .
Manhattan . . . . . . . . . . . . . .
Margarita . . . . . . . . . . . . . . .
Mimosa. . . . . . . . . . . . . . . . .
Mojito . . . . . . . . . . . . . . . . . .
Piña Colada . . . . . . . . . . . . .
Rum & Coke . . . . . . . . . . . . .
Scotch & Water. . . . . . . . . . .
Screwdriver. . . . . . . . . . . . . .
7 & 7. . . . . . . . . . . . . . . . . . .
Vodka Martini . . . . . . . . . . . .
Vodka & Cranberry . . . . . . . .
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
Vodka & Tonic . . . . . . . . . . . . Whiskey Sour . . . . . . . . . . . . White Russian . . . . . . . . . . . 24
25
26
999
OTHER (Write In)
You Personally:
Drank in
last 6
months
RUM
11
13
................. FORMS:
Shot or Neat (no ice) . . . . . . On the rocks (over ice) . . . . . Mixed drink . . . . . . . . . . . . . . TOTAL:
15
BRANDS:
Alizé . . . . . . . . . . . . . . . . . . .
Amaretto Di Amore . . . . . . . .
Bailey’s Orig. Irish Cream . . .
Carolans Irish Cream . . . . . .
Chambord. . . . . . . . . . . . . . .
12
You Personally:
Drank in
Drinks or
last 6
glasses/
months
last 30 days
155
08
OTHER (Write In)
TOTAL:
TYPES OF DRINKS
153
................. CHAMPAGNE &
SPARKLING WINES
You Personally:
Drank in
Drinks or
last 6
glasses/
months
last 30 days
Drinks or
glasses/
last 30 days
160
TOTAL:
................. TYPES:
Light . . . . . . . . . . . . . . . . . . . Dark . . . . . . . . . . . . . . . . . . . Gold . . . . . . . . . . . . . . . . . . . KINDS:
Flavored . . . . . . . . . . . . . . . . Non-Flavored . . . . . . . . . . . . BRANDS:
Admiral Nelson’s . . . . . . . . . .
Appleton Estate . . . . . . . . . .
Bacardi Big Apple . . . . . . . . .
Bacardi Gold. . . . . . . . . . . . .
Bacardi Light/Regular/
Superior . . . . . . . . . . . . . .
Bacardi Limón . . . . . . . . . . .
Other Bacardi . . . . . . . . . . . .
Calico Jack . . . . . . . . . . . . . .
Capt. Morgan Parrot Bay . . .
Capt. Morgan Spiced . . . . . .
Other Capt. Morgan . . . . . . .
Cruzan . . . . . . . . . . . . . . . . .
DonQ . . . . . . . . . . . . . . . . . .
Gosling’s. . . . . . . . . . . . . . . .
Kraken . . . . . . . . . . . . . . . . .
Malibu Coconut . . . . . . . . . .
Other Malibu. . . . . . . . . . . . .
Mount Gay . . . . . . . . . . . . . .
Myers’s . . . . . . . . . . . . . . . . .
Unspecified brand at bar/
restaurant . . . . . . . . . . . . .
OTHER (Write In)
OTHER (Write In)
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
999
BEVERAGES
Page 23
COGNAC
You Personally:
Drank in
Drinks or
last 6
glasses/
months
last 30 days
IRISH WHISKEY
158
TOTAL:
................. 00
01
02
03
999
OTHER (Write In)
You Personally:
Drank in
Drinks or
last 6
glasses/
months
last 30 days
159
TOTAL:
................. BRANDS:
Christian Brothers. . . . . . . . .
E&J. . . . . . . . . . . . . . . . . . . .
Korbel . . . . . . . . . . . . . . . . . .
Paul Masson/Grand Amber .
restaurant . . . . . . . . . . . . .
TOTAL:
01
03
04
05
999
You Personally:
Drank in
Drinks or
last 6
glasses/
months
last 30 days
00
KINDS:
02
BRANDS:
Basil Hayden’s . . . . . . . . . . .
Early Times. . . . . . . . . . . . . .
Evan Williams . . . . . . . . . . . .
Gentleman Jack . . . . . . . . . .
Jack Daniel’s . . . . . . . . . . . .
03
04
05
06
07
Jim Beam . . . . . . . . . . . . . . .
Jim Beam Devil’s Cut . . . . . .
Knob Creek . . . . . . . . . . . . .
Maker’s Mark . . . . . . . . . . . .
Red Stag . . . . . . . . . . . . . . .
08
09
10
11
12
Wild Turkey . . . . . . . . . . . . . . Woodford Reserve . . . . . . . . Unspecified brand at bar/
restaurant . . . . . . . . . . . . . 13
14
CANADIAN WHISKY
You Personally:
Drank in
Drinks or
last 6
glasses/
months
last 30 days
165
TOTAL:
................. BRANDS:
Black Velvet . . . . . . . . . . . . .
Canadian Club . . . . . . . . . . .
Canadian Mist . . . . . . . . . . .
Crown Royal . . . . . . . . . . . . .
Fireball . . . . . . . . . . . . . . . . .
Seagram’s VO . . . . . . . . . . .
Other Seagram’s . . . . . . . . .
Windsor Canadian . . . . . . . .
restaurant . . . . . . . . . . . . .
OTHER (Write In)
00
01
02
03
04
05
06
07
08
09
999
999
04
You Personally:
Drank in
Drinks or
last 6
glasses/
months
last 30 days
BRANDS:
Seagram’s 7 Crown . . . . . . . Unspecified brand at bar/
restaurant . . . . . . . . . . . . . 00
01
02
999
OTHER (Write In)
SCOTCH WHISKY
You Personally:
Drank in
Drinks or
last 6
glasses/
months
last 30 days
164
................. 00
BRANDS:
Chivas Regal . . . . . . . . . . . .
Dewar’s 12 . . . . . . . . . . . . . .
Dewar’s White Label. . . . . . .
Glenfiddich . . . . . . . . . . . . . .
The Glenlivet . . . . . . . . . . . .
01
02
03
04
05
Glenmorangie. . . . . . . . . . . .
J & B. . . . . . . . . . . . . . . . . . .
Johnnie Walker Black Label
Johnnie Walker Red Label . .
Other Johnnie Walker . . . . .
06
07
08
09
10
11
12
13
999
The Macallan . . . . . . . . . . . .
Other Blended Scotches . . . .
Other Single Malt Scotches .
restaurant . . . . . . . . . . . . .
OTHER (Write In)
999
01
02
03
................. 15
OTHER (Write In)
163
TOTAL:
TOTAL:
161
................. TOTAL:
00
OTHER (Write In)
00
02
................. RYE OR BLENDED
WHISKEY
TEQUILA
14
You Personally:
Drank in
Drinks or
last 6
glasses/
months
last 30 days
168
................. 00
KINDS:
Silver/White . . . . . . . . . . . . . Gold . . . . . . . . . . . . . . . . . . . Añejo/Reposado . . . . . . . . . . 01
02
03
TOTAL:
BRANDS:
Avión. . . . . . . . . . . . . . . . . . .
Camarena. . . . . . . . . . . . . . .
Cazadores . . . . . . . . . . . . . .
Don Julio . . . . . . . . . . . . . . .
1800 Tequila . . . . . . . . . . . . .
Herradura . . . . . . . . . . . . . . .
Hornitos . . . . . . . . . . . . . . . .
Jose Cuervo . . . . . . . . . . . . .
Margaritaville . . . . . . . . . . . .
Patrón. . . . . . . . . . . . . . . . . .
Sauza . . . . . . . . . . . . . . . . . .
restaurant . . . . . . . . . . . . .
OTHER (Write In)
You Personally:
Drank in
Drinks or
last 6
glasses/
months
last 30 days
166
BRANDS:
Bushmills . . . . . . . . . . . . . . .
Jameson. . . . . . . . . . . . . . . .
Tullamore Dew . . . . . . . . . . .
restaurant . . . . . . . . . . . . .
OTHER (Write In)
BOURBON
VODKA
162
BRANDS:
Courvoisier . . . . . . . . . . . . . . Hennessy . . . . . . . . . . . . . . . Rémy Martin. . . . . . . . . . . . . BRANDY
You Personally:
Drank in
Drinks or
last 6
glasses/
months
last 30 days
................. 00
KINDS:
TOTAL:
BRANDS:
Absolut . . . . . . . . . . . . . . . . .
Absolut Citron . . . . . . . . . . . .
Absolut Mandrin . . . . . . . . . .
Other Absolut . . . . . . . . . . . .
Belvedere . . . . . . . . . . . . . . .
Burnett’s . . . . . . . . . . . . . . . .
Cîroc. . . . . . . . . . . . . . . . . . .
Finlandia. . . . . . . . . . . . . . . .
Gordon’s . . . . . . . . . . . . . . . .
Grey Goose . . . . . . . . . . . . .
Grey Goose Flavored . . . . . .
Ketel One . . . . . . . . . . . . . . .
New Amsterdam . . . . . . . . . .
Pearl . . . . . . . . . . . . . . . . . . .
Pinnacle . . . . . . . . . . . . . . . .
Popov . . . . . . . . . . . . . . . . . .
Pucker . . . . . . . . . . . . . . . . .
Russian Standard. . . . . . . . .
Seagram’s . . . . . . . . . . . . . .
Skinnygirl . . . . . . . . . . . . . . .
Skyy . . . . . . . . . . . . . . . . . . .
Smirnoff No. 21 (80 proof) . .
Smirnoff Twist (Flavors) . . . .
Stolichnaya . . . . . . . . . . . . . .
Stoli Flavored Vodka . . . . . . .
Svedka . . . . . . . . . . . . . . . . .
Three Olives . . . . . . . . . . . . .
Tito’s . . . . . . . . . . . . . . . . . . .
UV . . . . . . . . . . . . . . . . . . . .
restaurant . . . . . . . . . . . . .
OTHER (Write In)
09
10
11
12
13
14
15
999
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
999
You Personally:
Drank in
Drinks or
last 6
glasses/
months
last 30 days
GIN
167
TOTAL:
................. BRANDS:
Beefeater . . . . . . . . . . . . . . .
Bombay . . . . . . . . . . . . . . . .
Bombay Sapphire. . . . . . . . .
Gilbey’s. . . . . . . . . . . . . . . . .
Gordon’s . . . . . . . . . . . . . . . .
Hendrick’s. . . . . . . . . . . . . . .
New Amsterdam . . . . . . . . . .
Seagram’s . . . . . . . . . . . . . .
Tanqueray. . . . . . . . . . . . . . .
restaurant . . . . . . . . . . . . .
OTHER (Write In)
04
05
06
07
08
01
00
01
02
03
04
05
06
07
08
09
10
999
ALCOHOLIC
BEVERAGES:
WHERE CONSUMED
In the last 30 days, where have you consumed
alcoholic beverages?
14U
Restaurant. . . . . . . . . . . . .
Bar/Club . . . . . . . . . . . . . .
Your Home. . . . . . . . . . . . .
Someone Else’s Home . . .
Other . . . . . . . . . . . . . . . . .
Beer
Wine
1
2
Liquor
01
02
03
04
05
3
CARS, TRUCKS, VANS, MINIVANS & SPORT UTILITY VEHICLES
Page 24
AUTOMOBILES AND
OTHER VEHICLES
How many vehicles do you or other members of your household currently own or personally lease? (Please include cars, trucks, vans, minivans
or sport utility vehicles and do not include company cars.) Include both domestic and imported vehicles. The first column is for the vehicle you
purchased or leased most recently, the next three columns are for the second, third, and fourth most recent purchase or lease.
One . . . . . . . . . . . 1
Three
. . . . . . . . 3
Two
Four
. . . . . . . . . 4
. . . . . . . . . . . 2
Five or more
None
. . . 5
169-0
. . . . . . . . . 0
Please fill in the following information for each vehicle currently owned or leased by you or other members of your household.
Most Recent
Purchase/
Lease
Make (e.g., Ford, Buick, Honda, Dodge, Chevrolet)
2nd Most
Recent
Purchase/
Lease
_________________
________________
170-0
183-0
3rd Most
Recent
Purchase/
Lease
_______________
196-0
4th Most
Recent
Purchase/
Lease
_______________
209-0
Model (e.g., Mustang, LaCrosse, Accord, Caravan, TrailBlazer) _________________
________________
_______________
_______________
Model Year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _________________
________________
_______________
_______________
171-0
184-0
197-0
210-0
Was vehicle purchased or leased?
Purchased . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Leased . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
172-0
18
29
185-0
18
29
198-0
18
28
18
29
Was vehicle bought new or used?
New. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Used (Certified Pre-Owned) . . . . . . . . . . . . . . . . . . . . . . . .
Used (Other) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
31
42
52
31
42
52
31
42
52
31
41
51
211-0
What type of vehicle is it?
Convertible . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Coupe/Sports Coupe/2 door . . . . . . . . . . . . . . . . . . . . . . . .
Sedan/Hard Top/4 door . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Sedan/Hard Top/2 door . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5 door Hatchback/Station Wagon . . . . . . . . . . . . . . . . . . . .
3 door Hatchback . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Van/Minivan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Sport Utility Vehicle (SUV) . . . . . . . . . . . . . . . . . . . . . . . . .
Truck (2 door) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Truck (4 door) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
173-0
1
2
3
4
5
6
7
8
9
0
186-0
1
2
3
4
5
6
7
8
9
0
199-0
1
2
3
4
5
6
7
8
9
0
212-0
1
2
3
4
5
6
7
8
9
0
What type of fuel does the vehicle use?
Gasoline (non-diesel) only . . . . . . . . . . . . . . . . . . . . . . . . .
Diesel Gasoline only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Combination Gas and Electricity (Hybrid vehicle). . . . . . . .
Other (e.g. Electricity only, Ethanol (E85), Hydrogen, etc.) .
174-0
1
2
3
4
187-0
1
2
3
4
200-0
1
2
3
4
213-0
1
2
3
4
Who decided which make to buy or lease?
Yourself . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yourself and someone else . . . . . . . . . . . . . . . . . . . . . . . . .
Someone else . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
6
7
5
6
7
5
6
7
5
6
7
When was vehicle purchased or leased?
In past 12 months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1-2 years ago . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3-4 years ago . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5 or more years ago . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
9
0
X
8
9
0
X
8
9
0
X
8
9
0
X
(If purchased) How was vehicle purchased?
(Check as many as apply.)
With cash . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
With trade-in . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
With financing from a dealer . . . . . . . . . . . . . . . . . . . . . . . .
With a bank loan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
With a credit union loan . . . . . . . . . . . . . . . . . . . . . . . . . . .
With financing from the auto manufacturer . . . . . . . . . . . . .
175-0
188-0
201-0
214-0
1
2
3
4
5
6
1
2
3
4
5
6
1
2
3
4
5
6
1
2
3
4
5
6
What was the total amount spent on purchase of vehicle?
$50,000 or more . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$40,000-49,999. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$30,000-39,999. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$20,000-29,999. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$15,000-19,999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$10,000-14,999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Under $10,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
(If leased) Which company (or companies) is the
vehicle leased from?
Bank . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
An auto manufacturer . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
9
0
8
9
0
8
9
0
8
9
0
176-0
189-0
202-0
215-0
Page 25
CARS, TRUCKS, VANS, MINIVANS & SPORT UTILITY VEHICLES
AUTOMOBILES AND
OTHER VEHICLES
(Continued)
Most Recent
Purchase/
Lease
2nd Most
Recent
Purchase/
Lease
3rd Most
Recent
Purchase/
Lease
4th Most
Recent
Purchase/
Lease
(If leased) What is the length of the lease?
24 months or less . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
36 months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
48 months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
60 months or longer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
177-0
1
2
3
4
190-0
1
2
3
4
203-0
1
2
3
4
217-0
1
2
3
4
Was vehicle bought or leased to replace another vehicle?
Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
6
5
6
5
6
5
6
Who is the principal driver?
Yourself (alone or with someone else) . . . . . . . . . . . . . . . . .
Someone else . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
8
7
8
7
8
7
8
Who is primarily responsible for maintenance?
Yourself (alone or with someone else) . . . . . . . . . . . . . . . . .
Someone else . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
0
9
0
9
0
9
0
What kind of transmission does the vehicle have?
Automatic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Manual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
178-0
1
2
191-0
1
2
204-0
1
2
218-0
1
2
What type of engine does the vehicle have?
4 cylinder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5 cylinder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6 cylinder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
V-6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
V-8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
4
5
6
7
8
3
4
5
6
7
8
3
4
5
6
7
8
3
4
5
6
7
8
Does the vehicle have these audio/entertainment features?
App/Internet connectivity . . . . . . . . . . . . . . . . . . . . . . . . . . .
Infotainment system (touchscreen) . . . . . . . . . . . . . . . . . . .
Custom speakers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
DVD player . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
MP3 player connection. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
179-0
1
2
3
4
5
192-0
1
2
3
4
5
205-0
1
2
3
4
5
219-0
1
2
3
4
5
Satellite Radio . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
WiFi Hotspot. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
7
6
7
6
7
6
7
Was the vehicle’s audio/entertainment system:
Standard with vehicle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Upgraded with vehicle . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
An aftermarket purchase . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
9
0
8
9
0
8
9
0
8
9
0
Does the vehicle have:
Air bags—driver/passenger side . . . . . . . . . . . . . . . . . . . . .
Air bags—side impact . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Anti-Lock braking system (ABS). . . . . . . . . . . . . . . . . . . . . .
Automatic Parking System . . . . . . . . . . . . . . . . . . . . . . . . . .
Bluetooth/Hands-free phone capability . . . . . . . . . . . . . . . .
Collision Avoidance System . . . . . . . . . . . . . . . . . . . . . . . . .
Custom (aluminum) wheels . . . . . . . . . . . . . . . . . . . . . . . . .
Four wheel drive/All wheel drive . . . . . . . . . . . . . . . . . . . . .
Front, Dual Automatic Climate Control . . . . . . . . . . . . . . . . .
GPS/Navigation system (Built-in, not portable) . . . . . . . . . .
180-0
1
2
3
4
5
193-0
1
2
3
4
5
206-0
1
2
3
4
5
220-0
1
2
3
4
5
6
7
8
9
0
6
7
8
9
0
6
7
8
9
0
6
7
8
9
0
Hands-Free Trunk Opener . . . . . . . . . . . . . . . . . . . . . . . . . .
Heated/Cooled Seats . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
X
Y
X
Y
X
Y
X
Y
181-0
1
1
1
1
2
3
4
5
6
2
3
4
5
6
2
3
4
5
6
2
3
4
5
6
In the past 12 months has your vehicle been serviced by:
Car dealer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Gas station/garage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Auto repair chain store . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Discount dept. store . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yourself . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yourself/someone else . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
8
9
0
X
Y
7
8
9
0
X
Y
7
8
9
0
X
Y
7
8
9
0
X
Y
In the past 12 months has vehicle had:
Alignment service/repair . . . . . . . . . . . . . . . . . . . . . . . . . . .
Brake lining or pad replacement . . . . . . . . . . . . . . . . . . . . .
Major engine repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Minor engine repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Paint job . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Tune-up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
182-0
1
2
3
4
5
6
1
2
3
4
5
6
1
2
3
4
5
6
1
2
3
4
5
6
7
7
7
7
Lane Departure alert . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
OnStar, Tele Aid or other Vehicle Monitoring System
(currently subscribing) . . . . . . . . . . . . . . . . . . . . . . . . . . .
Radar Detector . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Security/burglar alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Sunroof/moonroof . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Turbo charger . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
For Trucks only:
For what purpose(s) is this vehicle used?
Hauling—Personal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Hauling—Business . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Local Transportation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Recreation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
9
0
194-0
195-0
8
9
0
207-0
208-0
8
9
0
221-0
222-0
8
9
0
ATV’S/MOTORCYCLES/TRUCK RENTAL/AUTO CLUBS
MOTORCYCLES
ATVs/UTVs
Do you or does anyone else in your household own any motorcycles?
234-0
Yes 1
No
2
If so, how many motorcycles does your whole household own?
One
1
Page 26
Two
2
What year model is it?
2017 . . . . . . . . . . . . . . . . . . . . . . . . . .
2016 . . . . . . . . . . . . . . . . . . . . . . . . . .
2015 . . . . . . . . . . . . . . . . . . . . . . . . . .
2014 . . . . . . . . . . . . . . . . . . . . . . . . . .
2013 . . . . . . . . . . . . . . . . . . . . . . . . . .
2012 or earlier . . . . . . . . . . . . . . . . . .
Was it bought new or used?
New . . . . . . . . . . . . . . . . . . . . . . . . . .
Used. . . . . . . . . . . . . . . . . . . . . . . . . .
Who decided which make to buy?
Yourself (alone or with
someone else) . . . . . . . . . . . . . . . . .
Someone else . . . . . . . . . . . . . . . . . .
When was motorcycle acquired?
In past 12 months. . . . . . . . . . . . . . . .
1-2 years ago . . . . . . . . . . . . . . . . . . .
3-4 years ago . . . . . . . . . . . . . . . . . . .
5 or more years ago . . . . . . . . . . . . . .
What type is it?
Off-road/dirt bike (Competition) . . . . .
Other off-road/dirt/trail bike . . . . . . . .
Dual purpose (off-road/street) . . . . . .
Street Bike:
Cruiser . . . . . . . . . . . . . . . . . . . . . .
Custom . . . . . . . . . . . . . . . . . . . . . .
Standard . . . . . . . . . . . . . . . . . . . . .
Touring . . . . . . . . . . . . . . . . . . . . . .
Sport/Performance . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . .
Which engine size is it?
Under 100cc . . . . . . . . . . . . . . . . . . . .
100-449cc. . . . . . . . . . . . . . . . . . . . . .
450-749cc. . . . . . . . . . . . . . . . . . . . . .
750-899cc . . . . . . . . . . . . . . . . . . . . .
900cc or larger . . . . . . . . . . . . . . . . . .
Which make is it?
BMW . . . . . . . . . . . . . . . . . . . . . . . . .
Harley Davidson . . . . . . . . . . . . . . . . .
Honda. . . . . . . . . . . . . . . . . . . . . . . . .
Kawasaki . . . . . . . . . . . . . . . . . . . . . .
KTM . . . . . . . . . . . . . . . . . . . . . . . . . .
Suzuki . . . . . . . . . . . . . . . . . . . . . . . .
Yamaha . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . .
Who is the primary rider?
Yourself. . . . . . . . . . . . . . . . . . . . . . . .
Someone else . . . . . . . . . . . . . . . . . .
How do you transport your off-road bike?
Truck
1
Trailer
235-0
Three or more 3
236-0
1
2
3
4
5
6
243-0
1
2
3
4
5
6
250-0
1
2
3
4
5
6
7
8
7
8
7
8
237-0
244-0
251-0
1
2
1
2
1
2
238-0
1
245-0
1
252-0
1
2
3
4
239-0
1
2
3
246-0
1
2
3
253-0
1
2
3
4
5
6
7
8
9
4
5
6
7
8
9
4
5
6
7
8
9
240-0
1
2
247-0
1
2
254-0
1
2
241-0
1
2
3
4
5
6
7
8
248-0
1
2
3
4
5
6
7
8
255-0
1
2
3
4
5
6
7
8
242-0
1
2
249-0
1
2
256-0
1
2
3
4
5
3
4
5
257-0
2
AUTO CLUBS/
ROADSIDE
ASSISTANCE
Which, if any, of these auto clubs or roadside assistance programs do
you belong to?
AAA . . . . . . . . . . . . . . . . . . . . . . . . . .
AARP Roadside Assistance . . . . . . . .
Allstate Motor Club . . . . . . . . . . . . . . .
Other Insurance Company Roadside
Assistance Program. . . . . . . . . . . . .
Car Dealer/Manufacturer/
Dealer Warranty. . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . .
260-0
1
2
3
4
5
6
No
2
229-0
Other
Purchase
3
4
5
228-0
1
One 1
2nd Most
Recent
Purchase
2
3
4
Yes
If so, how many does your whole household own?
Most
Recent
Purchase
2
3
4
Do you or does anyone else in your household own any ATVs or utility
vehicles (UTVs)?
Two 2
Three or more 3
Most
Recent
Purchase
Other
Purchase(s)
230-0
232-0
1
2
3
1
2
3
4
5
6
7
8
9
0
X
4
5
6
7
8
9
0
X
231-0
233-0
1
2
3
4
1
2
3
4
What is it used for?
Recreation . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Both Recreation and Work . . . . . . . . . . . . . . . . .
5
6
7
5
6
7
How is it transported?
Truck. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Trailer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
9
8
9
Who is the primary rider?
Yourself. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Someone else . . . . . . . . . . . . . . . . . . . . . . . . . .
0
X
0
X
What kind is it?
Utility ATV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Sport ATV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Utility Vehicle (UTV) . . . . . . . . . . . . . . . . . . . . . .
Which make is it?
Arctic Cat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Honda . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
John Deere . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Kawasaki . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Polaris . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Suzuki . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yamaha . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
When was it acquired?
In past 12 months. . . . . . . . . . . . . . . . . . . . . . . .
1-2 years ago . . . . . . . . . . . . . . . . . . . . . . . . . . .
3-4 years ago . . . . . . . . . . . . . . . . . . . . . . . . . . .
5 or more years ago . . . . . . . . . . . . . . . . . . . . . .
TRUCK/TRAILER
RENTAL
Have you personally rented a truck/trailer in the last twelve months?
Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Which company (or companies) did you rent from:
Budget . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Enterprise. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Penske . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
U-Haul . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
258-0
1
2
3
4
5
6
OTHER (Write In)
Reason for rental of truck or trailer:
Moving personal/household goods. . . . . . . . . . . . . . . . 7
Commercial/business purposes . . . . . . . . . . . . . . . . . . 8
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
PROFESSIONAL
MOVING VAN
61X-0
Have you used a professional moving van line in the last 12 months?
Yes 1
AUTOMOTIVE/TRAFFIC REPORTS
Page 27
:
AUTOS/OTHER
VEHICLE INSURANCE
Number of vehicles in
your household covered
by insurance:
Cars/
Trucks/
Vans/
SUVs
Other
Vehicles
(e.g. Motorcycles,
ATVs, RVs,
Marine)
64V
1
None . . . . . . . . . . . . . . . . . .
One . . . . . . . . . . . . . . . . . . .
Two . . . . . . . . . . . . . . . . . . .
Three or more . . . . . . . . . . .
2
With which company(s)?
01
02
03
04
64W
1
AAA . . . . . . . . . . . . . . . . . . .
AARP from The Hartford . . .
Allstate . . . . . . . . . . . . . . . . .
American Family . . . . . . . . .
Amica. . . . . . . . . . . . . . . . . .
Encompass . . . . . . . . . . . . .
Esurance . . . . . . . . . . . . . . .
Farm Bureau . . . . . . . . . . . .
Farmers Insurance Group . .
GEICO . . . . . . . . . . . . . . . . .
The General . . . . . . . . . . . . .
The Hartford. . . . . . . . . . . . .
Infinity . . . . . . . . . . . . . . . . .
Liberty Mutual . . . . . . . . . . .
Mercury . . . . . . . . . . . . . . . .
MetLife . . . . . . . . . . . . . . . . .
Nationwide . . . . . . . . . . . . . .
Progressive . . . . . . . . . . . . .
SafeAuto . . . . . . . . . . . . . . .
State Farm . . . . . . . . . . . . . .
Travelers. . . . . . . . . . . . . . . .
21st Century . . . . . . . . . . . . .
USAA . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . .
How was it acquired?
From an agent . . . . . . . . . . .
Direct from insurance
company via phone . . . . .
company via website . . . .
At place of work or union . . .
At dealership where car/
vehicle was purchased
or leased . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . .
2
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
262-0
1
3
4
5
6
What type carried?
Collision . . . . . . . . . . . . . . . .
Liability- Bodily Injury . . . . . .
Liability- Property Damage. .
Medical Payments . . . . . . . .
Uninsured Motorist. . . . . . . .
Comprehensive . . . . . . . . . .
Towing . . . . . . . . . . . . . . . . .
263-0
1
2
3
4
5
6
7
8
9
264-0
1
2
3
4
5
6
7
How many times, if any, have you changed your
auto insurance carrier in the last 5 years?
Did not change. . . . . . . . . .
One time . . . . . . . . . . . . . .
Two times . . . . . . . . . . . . . .
Three or more times. . . . . .
64X-0
. 1
. 2
. 3
. 4
Did you acquire a new or different policy in the
last 12 months?
Yes 1 268-0
For business use you:
Rented/
Times/
last 12
last 12
months
months
269
TOTAL:
................. FROM WHAT COMPANIES:
Alamo . . . . . . . . . . . . . . . . . .
Avis. . . . . . . . . . . . . . . . . . . .
Budget . . . . . . . . . . . . . . . . .
Dollar . . . . . . . . . . . . . . . . . .
Enterprise. . . . . . . . . . . . . . .
Hertz. . . . . . . . . . . . . . . . . . .
Hertz On Demand . . . . . . . .
National . . . . . . . . . . . . . . . .
Thrifty . . . . . . . . . . . . . . . . . .
Zipcar . . . . . . . . . . . . . . . . . .
OTHER (Write In)
00
01
02
03
04
05
06
07
08
09
10
999
WHERE RENTED:
270-0
Airport . . . . . . . . . . . . . . . . . 1
Adjacent to airport . . . . . . . . 2
At home (local rental) . . . . . . 3
Somewhere else. . . . . . . . . . 4
Your organization’s guidelines on rentals for
271-0
business use:
I can rent from any firm I like. . . . . . . . . . . . . 1
I must always rent from specified firm(s) . . . 2
Most recent rental (choose one):
274-0
Alamo . . . . . . . . . 1 Hertz . . . . . . . . . . 6
Avis . . . . . . . . . . . 2 Hertz On Demand 7
Budget. . . . . . . . . 3 National . . . . . . . . 8
Dollar. . . . . . . . . . 4 Thrifty . . . . . . . . . 9
Enterprise . . . . . . 5 Zipcar . . . . . . . . . 0
Other . . . . . . . . . . X
CAR RENTAL
PERSONAL USE
2
How did you hear about the company?
Insurance agent . . . . . . . . .
Newspaper or magazine ad. .
Television or radio ad. . . . . .
Internet ad . . . . . . . . . . . . . .
Search engine . . . . . . . . . . .
Direct mail at home . . . . . . .
Internet quote
comparison service . . . . .
Family or Friends . . . . . . . .
Other . . . . . . . . . . . . . . . . . .
CAR RENTAL
BUSINESS USE
You Personally:
Rented/
Times/
last 12
last 12
months
months
272
TOTAL:
................. FROM WHAT COMPANIES:
Alamo . . . . . . . . . . . . . . . . . .
Avis. . . . . . . . . . . . . . . . . . . .
Budget . . . . . . . . . . . . . . . . .
Dollar . . . . . . . . . . . . . . . . . .
Enterprise. . . . . . . . . . . . . . .
Hertz. . . . . . . . . . . . . . . . . . .
Hertz On Demand . . . . . . . .
National . . . . . . . . . . . . . . . .
Thrifty . . . . . . . . . . . . . . . . . .
Zipcar . . . . . . . . . . . . . . . . . .
OTHER (Write In)
00
01
02
03
04
05
06
07
08
09
10
999
Average
Weekday
Average
Weekend
64E
01
02
03
04
05
Taxi . . . . . . . . . . . . . . . . . . . Lyft. . . . . . . . . . . . . . . . . . . . Uber . . . . . . . . . . . . . . . . . . Other Mobile app-based Car
service/Rideshare . . . . . . Bus . . . . . . . . . . . . . . . . . . . 06
07
08
Subway/Metro . . . . . . . . . . . Train. . . . . . . . . . . . . . . . . . . Other . . . . . . . . . . . . . . . . . . 11
12
13
Walking . . . . . . . . . . . . . . . .
Bicycle. . . . . . . . . . . . . . . . .
Driving (not in a carpool). . .
Driving in a carpool . . . . . . .
Motorcycle . . . . . . . . . . . . . .
1
09
10
2
DRIVING
Do you personally have a current driver’s
license? 278-0
Yes . . . . . . . . . . . . . . . . . . . . 1
Which vehicle(s) do you drive?
Automobile . . . . . . . . . . . . . . 2
Motorcycle . . . . . . . . . . . . . . 3
Van. . . . . . . . . . . . . . . . . . . . 4
Minivan . . . . . . . . . . . . . . . . 5
Compact Pick-up . . . . . . . . . 6
Regular Pick-up . . . . . . . . . .
Heavy Duty Truck. . . . . . . . .
Recreational Vehicle . . . . . .
Sport/Utility Vehicle . . . . . . .
Other Truck . . . . . . . . . . . . .
Other Vehicle . . . . . . . . . . . .
7
8
9
0
X
Y
Number of miles you personally drove in the
past 12 months:
279-0
None . . . . . . . . . . . 1
5 0,001-49,999 . . . . . . . . . . . 2
5 1,000-42,999 . . . . . . . . . . . 3
3 3,000-44,999 . . . . . . . . . . . 4
5 5,000-47,999 . . . . . . . . . . . 5
6
7
8
9
0
40,000-49,999 . . . . . . . . . . . X
50,000 or more . . . . . . . . . . Y
WHY RENTED:
Leisure . . . . . . . . . . . . . . . . . . 5
Own car in accident/repair . . . 6
Other. . . . . . . . . . . . . . . . . . . . 7
Most recent rental (choose one): 336-0
Alamo . . . . . . . . . 1 Hertz . . . . . . . . . .
Avis . . . . . . . . . . . 2 Hertz On Demand
Budget. . . . . . . . . 3 National . . . . . . . .
Dollar. . . . . . . . . . 4 Thrifty . . . . . . . . .
Enterprise . . . . . . 5 Zipcar . . . . . . . . .
Other . . . . . . . . . .
Transportation method(s), if any, you use on an
average weekday and average weekend:
5 8,000-49,999 . . . . . . . . . . .
10,000-14,999 . . . . . . . . . . .
15,000-19,999 . . . . . . . . . . .
20,000-29,999 . . . . . . . . . . .
30,000-39,999 . . . . . . . . . . .
WHERE RENTED:
273-0
Airport . . . . . . . . . . . . . . . . . . 1
Adjacent to airport . . . . . . . . . 2
At home (local rental) . . . . . . . 3
Somewhere else. . . . . . . . . . . 4
HOW RENTED:
Direct from company/walk-in
(no reservation). . . . . . . . . . . . . . . . . . . . .
Direct from company by phone . . . . . . . . . .
Direct from company via company's
website . . . . . . . . . . . . . . . . . . . . . . . . . . .
Through general travel or price comparison
website . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
YOUR
TRANSPORTATION
Primary reason(s) you personally drive:
651-0
8
9
Commute to work . . . . . . . . .
Other driving for work. . . . . .
Leisure . . . . . . . . . . . . . . . . .
Errands. . . . . . . . . . . . . . . . .
Transport others. . . . . . . . . .
Other . . . . . . . . . . . . . . . . . .
0
1
2
3
4
5
6
X
Y
TRAFFIC REPORTS
6
7
8
9
0
X
If you have listened to traffic reports on the
radio in the past 12 months, how often did you
64Y-0
do so?
Regularly . . . . . . . . . . . . . . . 1
Occasionally . . . . . . . . . . . . 2
AUTOMOTIVE PRODUCTS
GASOLINE
You Personally:
Bought in
Gallons/
last 6
last 7
months
days
Page 28
GASOLINE ADDITIVES
OTHER (Write In)
MOTOR OIL
ADDITIVES
284
280
TOTAL: . . . . . . . . . . . . . . . . .
GRADES:
Premium/Super. . . . . . . . . . .
Mid-Grade . . . . . . . . . . . . . .
Regular. . . . . . . . . . . . . . . . .
TYPES:
Unleaded . . . . . . . . . . . . . . .
Diesel . . . . . . . . . . . . . . . . . .
Gasohol . . . . . . . . . . . . . . . .
KINDS:
Full-service . . . . . . . . . . . . . .
Self-service . . . . . . . . . . . . .
BRANDS:
Arco . . . . . . . . . . . . . . . . . . .
BP/Amoco . . . . . . . . . . . . . .
Chevron . . . . . . . . . . . . . . . .
Citgo. . . . . . . . . . . . . . . . . . .
Clark. . . . . . . . . . . . . . . . . . .
Conoco . . . . . . . . . . . . . . . . .
Exxon . . . . . . . . . . . . . . . . . .
Getty. . . . . . . . . . . . . . . . . . .
Gulf. . . . . . . . . . . . . . . . . . . .
Hess . . . . . . . . . . . . . . . . . . .
Marathon . . . . . . . . . . . . . . .
Mobil. . . . . . . . . . . . . . . . . . .
Phillips 66. . . . . . . . . . . . . . .
Quik Trip . . . . . . . . . . . . . . . .
Racetrac . . . . . . . . . . . . . . . .
7-Eleven . . . . . . . . . . . . . . . .
76 . . . . . . . . . . . . . . . . . . . . .
Shell . . . . . . . . . . . . . . . . . . .
Sinclair . . . . . . . . . . . . . . . . .
Speedway. . . . . . . . . . . . . . .
Sunoco . . . . . . . . . . . . . . . . .
SuperAmerica . . . . . . . . . . .
Texaco . . . . . . . . . . . . . . . . .
Valero . . . . . . . . . . . . . . . . . .
Walmart . . . . . . . . . . . . . . . .
Warehouse/Club Store . . . . .
You Personally:
Bought in
Bottles/
last 12
last 12
months
months
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
999
On average, how many times a week do you
purchase gas?
More than 3 times per week . .
3 times per week . . . . . . . . . . .
2 times per week . . . . . . . . . . .
1 time per week. . . . . . . . . . . .
Less than 1 time per week . . .
276-0
1
2
3
4
5
291
................. BRANDS:
Chevron Techron . . . . . . . . .
Gumout . . . . . . . . . . . . . . . .
Heet . . . . . . . . . . . . . . . . . . .
Lucas . . . . . . . . . . . . . . . . . .
104+ Octane Boost. . . . . . . .
Prestone . . . . . . . . . . . . . . . .
Sea Foam. . . . . . . . . . . . . . .
STA-BIL Fuel Stabilizer. . . . .
STP Fuel Injector and
Carburetor Treatment . . . .
STP Gas Treatment . . . . . . .
STP Super Concentrated
Fuel Injector Cleaner. . . . .
Other STP . . . . . . . . . . . . . .
Valvoline . . . . . . . . . . . . . . . .
OTHER (Write In)
281-0
1
2
3
4
5
6
How did you pay for your gasoline in the last
30 days?
282-0
1
Cash. . . . . . . . . . . . . . . . . . . . . . . .
Credit Card:
Oil Company/Gasoline Card . . . . 2
General Purpose Card . . . . . . . . 3
Debit Card . . . . . . . . . . . . . . . . . . . 4
00
01
02
03
04
05
06
07
08
09
10
11
12
13
999
TOTAL:
................. BRANDS:
Bar’s Leaks. . . . . . . . . . . . . .
Dura Lube. . . . . . . . . . . . . . .
Lucas . . . . . . . . . . . . . . . . . .
Marvel Mystery Oil . . . . . . . .
NO-LEAK Sealer . . . . . . . . .
Prolong . . . . . . . . . . . . . . . . .
Restore. . . . . . . . . . . . . . . . .
Slick 50 Engine Treatment . .
STP . . . . . . . . . . . . . . . . . . .
00
01
02
03
04
05
06
07
08
09
999
OTHER (Write In)
Who decides which brand you buy?
292-0
someone else) . . . . . . . . . 1
Someone else . . . . . . . . . . . 2
Who adds it?
Who adds it?
285-0
Yourself . . . . . . . . . . . . . . . . 1
Another household member 2
Service centers or dealers,
etc. . . . . . . . . . . . . . . . . . . 3
Other . . . . . . . . . . . . . . . . . . 4
OIL FILTERS
Yourself . . . . . . . . . . . . . . . .
Another household member
etc. . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . .
You Personally:
Bought in
Number/
last 12
last 12
months
months
ANTI-FREEZE/
COOLANT
286
TOTAL:
BRANDS:
ACDelco . . . . . . . . . . . . . . . .
Bosch . . . . . . . . . . . . . . . . . .
Champion. . . . . . . . . . . . . . .
Fram . . . . . . . . . . . . . . . . . . .
K&N . . . . . . . . . . . . . . . . . . .
Mobil 1 . . . . . . . . . . . . . . . . .
Mopar . . . . . . . . . . . . . . . . . .
Motorcraft . . . . . . . . . . . . . . .
NAPA . . . . . . . . . . . . . . . . . .
Pennzoil . . . . . . . . . . . . . . . .
Purolator . . . . . . . . . . . . . . . .
Quaker State . . . . . . . . . . . .
WIX. . . . . . . . . . . . . . . . . . . .
Who installed?
Yourself . . . . . . . . . . . . . . . .
Service centers or dealers . .
Other . . . . . . . . . . . . . . . . . .
Where bought?
Advance Auto Parts Store . .
AutoZone . . . . . . . . . . . . . . .
NAPA . . . . . . . . . . . . . . . . . .
O’Reilly Auto Parts. . . . . . . .
Pep Boys . . . . . . . . . . . . . . .
Quick Lube Center. . . . . . . .
Walmart . . . . . . . . . . . . . . . .
293-0
1
2
3
4
You Personally:
Bought in
Gallons/
last 12
last 12
months
months
294
................. OTHER (Write In)
Amount spent on gasoline in the last 30 days?
$ 1 - $ 49 . . . . . . . . . . . . . .
$ 50 - $ 74 . . . . . . . . . . . . . .
$175 - $199 . . . . . . . . . . . . . .
$100 - $149 . . . . . . . . . . . . . .
$150 - $199 . . . . . . . . . . . . . .
$200 or more . . . . . . . . . . . . .
TOTAL:
You Personally:
Bought in
Bottles/
last 12
last 12
months
months
287-0
1
2
3
4
288-0
1
2
3
4
5
6
7
289-0
Other auto parts store . . . . . 1
Car dealer . . . . . . . . . . . . . . 2
Discount auto store . . . . . . . 3
Gas station/garage . . . . . . . 4
Other Discount/Dept. Store 5
290-0
someone else) . . . . . . . . . 1
Someone else . . . . . . . . . . . 2
00
01
02
03
04
05
06
07
08
09
10
11
12
13
999
TOTAL:
................. BRANDS:
Havoline . . . . . . . . . . . . . . . .
Mobil. . . . . . . . . . . . . . . . . . .
NAPA . . . . . . . . . . . . . . . . . .
Peak . . . . . . . . . . . . . . . . . . .
Prestone . . . . . . . . . . . . . . . .
Quaker State . . . . . . . . . . . .
Zerex . . . . . . . . . . . . . . . . . .
OTHER (Write In)
00
01
02
03
04
05
06
07
999
295-0
Yourself (alone or with someone else) . . 1
Someone else. . . . . . . . . . . . . . . . . . . . . 2
When do you change it?
296-0
Winter only . . . . . . . . . . . . . . . . . . . . . . . 1
Summer only. . . . . . . . . . . . . . . . . . . . . . 2
Year round. . . . . . . . . . . . . . . . . . . . . . . . 3
Who adds it for you?
Yourself . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Another household member . . . . . . . . . . . 5
Service centers or dealers, etc. . . . . . . . 6
Other. . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
When you change anti-freeze, do you:
Drain radiator completely . . . . . . . . . . . . 8
Drain radiator partially. . . . . . . . . . . . . . . 9
Top off radiator . . . . . . . . . . . . . . . . . . . . 0
Where bought?
297-0
Advance Auto Parts Store . . . . . . . . . . . . 1
AutoZone . . . . . . . . . . . . . . . . . . . . . . . . 2
Kmart . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Pep Boys. . . . . . . . . . . . . . . . . . . . . . . . . 4
Sears . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Walmart . . . . . . . . . . . . . . . . . . . . . . . . . 6
Other auto parts store. . . . . . . . . . . . . . . 7
Gas Station. . . . . . . . . . . . . . . . . . . . . . . 8
Grocery/Supermarket . . . . . . . . . . . . . . . 9
Other Discount/Dept. Store . . . . . . . . . . . . 0
AUTOMOTIVE PRODUCTS
Page 29
MOTOR OIL
You Personally:
Bought/
changed
Quarts/
in last 12
last 12
months
months
AIR FILTERS
OTHER (Write In)
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
999
Who adds or changes it for you?
299-0
Yourself. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Other household member . . . . . . . . . . . . . . 2
Gas station/garage. . . . . . . . . . . . . . . . . . . . 3
Car dealer . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Tire dealer . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Auto repair chain store . . . . . . . . . . . . . . . . . 6
Jiffy Lube . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Valvoline Instant Oil Change . . . . . . . . . . . . 8
Other Quick Lube Center . . . . . . . . . . . . . . . 9
Walmart TLE . . . . . . . . . . . . . . . . . . . . . . . . 0
Other Discount Store Service Center . . . . . . X
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Y
If you personally change your oil, where did
you purchase it?
300-0
Advance Auto Parts Store. . . . . . . . . . . . . . . 1
AutoZone . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
O’Reilly Auto Parts . . . . . . . . . . . . . . . . . . . . 3
Pep Boys . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Walmart . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Other auto parts store . . . . . . . . . . . . . . . . . 6
Gas Station/garage . . . . . . . . . . . . . . . . . . . 7
Other Discount/Dept. Store . . . . . . . . . . . . . 8
Who decides which brand you use?
301-0
Yourself (alone or with someone else) . . . . . 1
Someone else . . . . . . . . . . . . . . . . . . . . . . . 2
BRAKES
You Personally:
Had serviced
in last 12
months
303-0
1
Yes COMPANIES:
Firestone . . . . . . . . . . . . . . . . . . . Meineke . . . . . . . . . . . . . . . . . . . . Midas . . . . . . . . . . . . . . . . . . . . . . Monro Muffler/Brake . . . . . . . . . . . Sears . . . . . . . . . . . . . . . . . . . . . . Other . . . . . . . . . . . . . . . . . . . . . . TRANSMISSION
SERVICE
2
3
4
5
6
7
You Personally:
Had serviced
in last 12
months
302-0
1
Yes
COMPANIES:
Aamco . . . . . . . . . . . . . . . . . . . . . Cottman . . . . . . . . . . . . . . . . . . . . Other . . . . . . . . . . . . . . . . . . . . . . 2
3
4
You Personally:
Bought
in last 12
months
MUFFLERS
304
298
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Conventional . . . . . . . . . . . .
High Mileage . . . . . . . . . . . .
Synthetic Blend . . . . . . . . . .
Full Synthetic . . . . . . . . . . . .
BRANDS:
Amsoil. . . . . . . . . . . . . . . . . .
Castrol Edge. . . . . . . . . . . . .
Castrol GTX . . . . . . . . . . . . .
Castrol GTX High Mileage . .
Castrol GTX Syn Blend . . . .
Chevron . . . . . . . . . . . . . . . .
ENEOS. . . . . . . . . . . . . . . . .
Havoline . . . . . . . . . . . . . . . .
Mobil 1 . . . . . . . . . . . . . . . . .
Mobil Super . . . . . . . . . . . . .
Motorcraft . . . . . . . . . . . . . . .
NAPA . . . . . . . . . . . . . . . . . .
Peak . . . . . . . . . . . . . . . . . . .
Pennzoil . . . . . . . . . . . . . . . .
Pennzoil Platinum. . . . . . . . .
Pennzoil Ultra . . . . . . . . . . . .
Quaker State . . . . . . . . . . . .
Royal Purple . . . . . . . . . . . . .
Shell . . . . . . . . . . . . . . . . . . .
Valvoline . . . . . . . . . . . . . . . .
Valvoline MaxLife . . . . . . . . .
You Personally:
Bought in
Number/
last 12
last 12
months
months
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
ACDelco . . . . . . . . . . . . . . . .
Champion. . . . . . . . . . . . . . .
Fram . . . . . . . . . . . . . . . . . . .
K&N ..................
Motorcraft . . . . . . . . . . . . . . .
NAPA . . . . . . . . . . . . . . . . . .
Pennzoil . . . . . . . . . . . . . . . .
Purolator . . . . . . . . . . . . . . . .
WIX. . . . . . . . . . . . . . . . . . . .
OTHER (Write In)
311-0
1
Yes 00
01
02
03
04
05
06
07
08
09
999
Who installed it?
305-0
Yourself . . . . . . . . . . . . . . . . 1
Another household member 2
Service centers or dealers. . 3
Other . . . . . . . . . . . . . . . . . . 4
BRANDS:
Flowmaster. . . . . . . . . . . . . . . . . . MagnaFlow. . . . . . . . . . . . . . . . . . Meineke . . . . . . . . . . . . . . . . . . . . Midas . . . . . . . . . . . . . . . . . . . . . . NAPA . . . . . . . . . . . . . . . . . . . . . . Other . . . . . . . . . . . . . . . . . . . . . . Who installed it?
312-0
Yourself . . . . . . . . . . . . . . . . . . . . . 1
Another household member . . . . . 2
Service center or dealer . . . . . . . . 3
Auto repair chain store . . . . . . . . . 4
Other . . . . . . . . . . . . . . . . . . . . . . 5
Where bought?
313-0
Meineke . . . . . . . . . . . . . . . . . . . . 1
Midas . . . . . . . . . . . . . . . . . . . . . . 2
Pep Boys . . . . . . . . . . . . . . . . . . . 3
Auto parts store . . . . . . . . . . . . . . 4
Car dealer. . . . . . . . . . . . . . . . . . . 5
Gas station/garage . . . . . . . . . . . . 6
Specialty muffler shop . . . . . . . . . 7
Other . . . . . . . . . . . . . . . . . . . . . . 8
Where bought?
306-0
Advance Auto Parts Store . . 1
AutoZone . . . . . . . . . . . . . . . 2
NAPA . . . . . . . . . . . . . . . . . . 3
Pep Boys . . . . . . . . . . . . . . . 4
Quick Lube Center. . . . . . . . 5
Walmart . . . . . . . . . . . . . . . . 6
Other auto parts store . . . . . 7
Car dealer . . . . . . . . . . . . . . 8
Discount auto store . . . . . . . 9
Gas station/garage . . . . . . . 0
Other Discount/Dept. Store X
314-0
Yourself (alone or with someone
else) . . . . . . . . . . . . . . . . . . . 1
Someone else . . . . . . . . . . . . . . . 2
308-0
someone else) . . . . . . . . . 1
Someone else . . . . . . . . . . . 2
LEATHER AND VINYL
PROTECTANTS
CAR WAX & POLISH
You Personally:
Bought in
Times
last 12
used/last
months
12 months
309
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Armor All Leather Wipes. . . .
Armor All Original
Protectant . . . . . . . . . . . . .
Armor All Protectant Wipes . .
Armor All Ultra Shine . . . . . .
Other Armor All. . . . . . . . . . .
00
01
02
03
04
05
Black Magic . . . . . . . . . . . . .
Lexol . . . . . . . . . . . . . . . . . . .
Meguiar’s . . . . . . . . . . . . . . .
Mothers . . . . . . . . . . . . . . . .
Turtle Wax. . . . . . . . . . . . . . .
OTHER (Write In)
CAR CLEANER
WASH/WIPES
310
OTHER (Write In)
06
07
08
09
10
999
You Personally:
Bought in
Times
last 12
used/last
months
12 months
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Spray detailer . . . . . . . . . . . .
Wash . . . . . . . . . . . . . . . . . .
Wipes . . . . . . . . . . . . . . . . . .
BRANDS:
Armor All . . . . . . . . . . . . . . .
Blue Coral. . . . . . . . . . . . . . .
Invisible Glass . . . . . . . . . . .
Meguiar’s . . . . . . . . . . . . . . .
Mothers . . . . . . . . . . . . . . . .
Nu Finish . . . . . . . . . . . . . . .
Rain-X . . . . . . . . . . . . . . . . .
Turtle Wax. . . . . . . . . . . . . . .
00
01
02
03
2
3
4
5
6
7
04
05
06
07
08
09
10
11
999
You Personally:
Bought in
Times
last 12
used/last
months
12 months
315
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Liquid . . . . . . . . . . . . . . . . . .
Paste . . . . . . . . . . . . . . . . . .
Spray . . . . . . . . . . . . . . . . . .
BRANDS:
Armor All Extreme Shield . . .
Black Magic . . . . . . . . . . . . .
Blue Coral. . . . . . . . . . . . . . .
Eagle One . . . . . . . . . . . . . .
Liquid Glass . . . . . . . . . . . . .
Meguiar’s Gold Class . . . . . .
Meguiar’s NXT Generation. .
Other Meguiar’s . . . . . . . . . .
Mothers . . . . . . . . . . . . . . . .
Nu Finish . . . . . . . . . . . . . . .
Rain Dance. . . . . . . . . . . . . .
Rain-X . . . . . . . . . . . . . . . . .
Simoniz . . . . . . . . . . . . . . . .
3M Wax . . . . . . . . . . . . . . . .
Turtle Wax Ice. . . . . . . . . . . .
Turtle Wax Super Hard Shell
Other Turtle Wax. . . . . . . . . .
00
01
02
03
OTHER (Write In)
Used for:
316-0
Boats . . . . . . . . . . . . . . . . . .
Cars . . . . . . . . . . . . . . . . . . .
Motorcycles . . . . . . . . . . . . .
Trucks . . . . . . . . . . . . . . . . . .
1
2
3
4
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
999
AUTOMOTIVE PRODUCTS
You Personally:
Bought
in last 12
months
CAR/OTHER
VEHICLE BATTERIES
SHOCK ABSORBERS/
STRUTS
317-0
1
Motorcraft . . . . . . . . . . . . . . . . . . . .
NAPA . . . . . . . . . . . . . . . . . . . . . . .
Optima . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . .
Who installed it?
TOTAL:
7
8
9
OTHER (Write In)
Yourself . . . . . . . . . . . . . . . . .
Service centers or dealers . .
Other . . . . . . . . . . . . . . . . . .
Where bought?
Advance Auto Parts Store. . .
AutoZone . . . . . . . . . . . . . . .
Midas . . . . . . . . . . . . . . . . . .
Pep Boys . . . . . . . . . . . . . . .
Sears . . . . . . . . . . . . . . . . . .
Other auto parts store . . . . .
Car dealer. . . . . . . . . . . . . . .
Gas station/garage . . . . . . . .
Specialty shop . . . . . . . . . . .
Tire Dealer . . . . . . . . . . . . . .
320-0
1
2
3
4
5
Advance Auto Parts Store. . . . . . . .
AutoZone . . . . . . . . . . . . . . . . . . . .
NAPA . . . . . . . . . . . . . . . . . . . . . . .
O’Reilly Auto Parts . . . . . . . . . . . . .
Pep Boys . . . . . . . . . . . . . . . . . . . .
Sears . . . . . . . . . . . . . . . . . . . . . . . 6
Walmart . . . . . . . . . . . . . . . . . . . . . 7
327-0
1
2
3
4
328-0
1
2
3
4
5
6
7
8
9
0
64L-0
someone else) . . . . . . . . . 1
Someone else . . . . . . . . . . . 2
SPARK PLUGS
You Personally:
Bought
Number/
in last 12
last 12
months
months
330
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
ACDelco . . . . . . . . . . . . . . . .
Autolite . . . . . . . . . . . . . . . . .
Bosch . . . . . . . . . . . . . . . . . .
Champion. . . . . . . . . . . . . . .
Motorcraft . . . . . . . . . . . . . . .
NGK . . . . . . . . . . . . . . . . . . .
322-0
someone else) . . . . . . . . . . . . . . 1
Someone else . . . . . . . . . . . . . . . . 2
You Personally:
Bought
Number/
in last 12
last 12
months
months
OTHER (Write In)
Who installed them for you?
324
OTHER (Write In)
Who installed them?
325-0
Yourself . . . . . . . . . . . . . . . . . 1
Another household member . 2
Other . . . . . . . . . . . . . . . . . . 3
00
01
02
03
04
05
06
07
08
09
999
331-0
Yourself . . . . . . . . . . . . . . . . . 1
Another household member . . 2
Other (including all dealers,
service centers, etc.). . . . . 3
Where bought?
Advance Auto Parts Store. . .
AutoZone . . . . . . . . . . . . . . .
NAPA . . . . . . . . . . . . . . . . . .
O’Reilly Auto Parts . . . . . . . .
Pep Boys . . . . . . . . . . . . . . .
Walmart . . . . . . . . . . . . . . . .
Other auto parts store . . . . .
Car dealer. . . . . . . . . . . . . . .
Gas station/garage . . . . . . . .
Other Discount/Dept. Store .
332-0
1
2
3
4
5
6
7
8
9
0
333-0
someone else) . . . . . . . . . 1
Someone else . . . . . . . . . . . 2
You Personally:
Number
Bought in purchased/
last 12
last 12
months
months
TOTAL: . . . . . . . . . . . . . . . . .
KINDS:
All terrain . . . . . . . . . . . . . . .
All season. . . . . . . . . . . . . . .
High performance. . . . . . . . .
Mud/Snow . . . . . . . . . . . . . .
Mud/Terrain . . . . . . . . . . . . .
Regular passenger . . . . . . . .
Touring . . . . . . . . . . . . . . . . .
BRANDS:
BFGoodrich . . . . . . . . . . . . .
Big O . . . . . . . . . . . . . . . . . .
Bridgestone . . . . . . . . . . . . .
Continental . . . . . . . . . . . . . .
Cooper . . . . . . . . . . . . . . . . .
Dunlop . . . . . . . . . . . . . . . . .
Falken. . . . . . . . . . . . . . . . . .
Firestone . . . . . . . . . . . . . . .
General . . . . . . . . . . . . . . . .
Goodyear . . . . . . . . . . . . . . .
Hankook . . . . . . . . . . . . . . . .
Kelly . . . . . . . . . . . . . . . . . . .
Kumho . . . . . . . . . . . . . . . . .
Michelin . . . . . . . . . . . . . . . .
Nexen . . . . . . . . . . . . . . . . . .
Pirelli. . . . . . . . . . . . . . . . . . .
Toyo . . . . . . . . . . . . . . . . . . .
Uniroyal . . . . . . . . . . . . . . . .
Yokohama . . . . . . . . . . . . . . .
OTHER (Write In)
329-0
Other auto parts store . . . . . . . . . .
Car dealer. . . . . . . . . . . . . . . . . . . .
Gas station/garage . . . . . . . . . . . . .
Tire Dealer/Store . . . . . . . . . . . . . .
Mobile Battery Service/Tow Truck. .
Other Discount/Dept. Store . . . . . . 6
Warehouse/Club Store . . . . . . . . . . 7
01
02
03
04
05
999
Other Discount/Dept. Store . 1
321-0
1
2
3
4
5
00
Who installed it?
318-0
1
2
3
4
Yourself . . . . . . . . . . . . . . . . . . . . . .
Another household member . . . . . .
etc. . . . . . . . . . . . . . . . . . . . . . . . 3
Mobile Battery Service/Tow Truck. . 4
Other . . . . . . . . . . . . . . . . . . . . . . . 5
Where bought?
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Anco . . . . . . . . . . . . . . . . . . .
Bosch . . . . . . . . . . . . . . . . . .
Michelin . . . . . . . . . . . . . . . .
Pylon . . . . . . . . . . . . . . . . . .
Rain-X . . . . . . . . . . . . . . . . .
Smart Blade . . . . . . . . . . . . .
Trico . . . . . . . . . . . . . . . . . . .
Tridon . . . . . . . . . . . . . . . . . .
Valeo . . . . . . . . . . . . . . . . . .
TIRES
334
................. BRANDS:
ACDelco . . . . . . . . . . . . . . . .
Gabriel . . . . . . . . . . . . . . . . .
GM Parts/Goodwrench. . . . .
Monroe . . . . . . . . . . . . . . . . .
NAPA . . . . . . . . . . . . . . . . . .
2
3
4
5
6
319-0
1
2
WINDSHIELD WIPERS
You Personally:
Bought
Number/
in last 12
last 12
months
months
326
Yes BRANDS:
AAA . . . . . . . . . . . . . . . . . . . . . . . .
ACDelco . . . . . . . . . . . . . . . . . . . . .
AutoCraft (Advance Auto Parts) . . .
DieHard (Sears) . . . . . . . . . . . . . . .
Duralast . . . . . . . . . . . . . . . . . . . . .
EverStart (Walmart) . . . . . . . . . . . .
Exide . . . . . . . . . . . . . . . . . . . . . . .
Interstate. . . . . . . . . . . . . . . . . . . . .
Page 30
00
01
02
03
04
05
06
999
Where bought?
America’s Tire. . . . . . . . . . . .
Big O Tires . . . . . . . . . . . . . .
Discount Tire Co. . . . . . . . . .
Firestone Complete Auto
Care . . . . . . . . . . . . . . . . .
Goodyear . . . . . . . . . . . . . . .
NTB National Tire & Battery
Pep Boys . . . . . . . . . . . . . . .
Sears . . . . . . . . . . . . . . . . . .
Walmart . . . . . . . . . . . . . . . .
Auto parts store . . . . . . . . . .
Gas station . . . . . . . . . . . . . .
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
999
335-0
1
2
3
4
5
6
7
8
9
0
X
323-0
Other tire dealer/Store . . . . . 1
Who decides which brand you buy? 337-0
someone else) . . . . . . . . . 1
Someone else . . . . . . . . . . . 2
How much did you spend for tires in the last
12 months?
338-0
Under $100. . . . . . . . . . . . . . 1
$100 - $249 . . . . . . . . . . . . . 2
$250 - $499 . . . . . . . . . . . . . 3
$500 or more . . . . . . . . . . . . 4
TIRE CARE
You Personally:
Bought in Times used/
last 12
last 12
months
months
283
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Shine . . . . . . . . . . . . . . . . . .
Wet/Gel. . . . . . . . . . . . . . . . .
Cleaner. . . . . . . . . . . . . . . . .
Foam . . . . . . . . . . . . . . . . . .
Spray/Aerosol . . . . . . . . . . . .
BRANDS:
Armor All. . . . . . . . . . . . . . . .
Black Magic . . . . . . . . . . . . .
Eagle One . . . . . . . . . . . . . .
Meguiar’s . . . . . . . . . . . . . . .
Mothers . . . . . . . . . . . . . . . .
Turtle Wax. . . . . . . . . . . . . . .
OTHER (Write In)
00
01
02
03
04
05
06
07
08
09
10
11
999
RESTAURANTS
Page 31
FAST FOOD & DRIVEIN RESTAURANTS
You Personally:
Ate/Bought Number of
at last
times/last
6 months
30 days
FAMILY
RESTAURANTS &
STEAK HOUSES
351
TOTAL:
353
................. RESTAURANTS:
A&W..................
Arby’s . . . . . . . . . . . . . . . . . .
Au Bon Pain . . . . . . . . . . . . .
Baja Fresh Mexican Grill . . .
Baskin-Robbins . . . . . . . . . .
Ben & Jerry’s . . . . . . . . . . . .
Blimpie Subs & Salads . . . . .
Bojangles . . . . . . . . . . . . . . .
Boston Market . . . . . . . . . . .
Burger King . . . . . . . . . . . . .
Captain D’s . . . . . . . . . . . . . .
Carl’s Jr. . . . . . . . . . . . . . . . .
Checkers . . . . . . . . . . . . . . .
Chick-Fil-A . . . . . . . . . . . . . .
Chipotle Mexican Grill . . . . .
Chuck E. Cheese . . . . . . . . .
Church’s Fried Chicken. . . . .
Cold Stone Creamery. . . . . .
Culver’s. . . . . . . . . . . . . . . . .
Dairy Queen . . . . . . . . . . . . .
Del Taco . . . . . . . . . . . . . . . .
Domino’s . . . . . . . . . . . . . . .
Dunkin’ Donuts . . . . . . . . . . .
Einstein Bros. Bagel Shop . .
El Pollo Loco . . . . . . . . . . . .
Fazoli’s . . . . . . . . . . . . . . . . .
Five Guys . . . . . . . . . . . . . . .
Fuddruckers . . . . . . . . . . . . .
Hardee’s . . . . . . . . . . . . . . . .
Jack in the Box . . . . . . . . . . .
Jamba Juice . . . . . . . . . . . . .
Jimmy John’s . . . . . . . . . . . .
KFC . . . . . . . . . . . . . . . . . . .
Krispy Kreme Doughnuts . . .
Krystal . . . . . . . . . . . . . . . . .
Little Caesars . . . . . . . . . . . .
Long John Silver’s . . . . . . . .
McDonald’s. . . . . . . . . . . . . .
Moe’s Southwest Grill. . . . . .
Noodles & Company . . . . . .
Orange Julius . . . . . . . . . . . .
Panda Express . . . . . . . . . . .
Panera Bread . . . . . . . . . . . .
Papa John’s . . . . . . . . . . . . .
Papa Murphy’s . . . . . . . . . . .
Pizza Hut . . . . . . . . . . . . . . .
Popeyes Chicken . . . . . . . . .
Qdoba Mexican Grill. . . . . . .
Quiznos . . . . . . . . . . . . . . . .
Rally’s . . . . . . . . . . . . . . . . . .
Round Table Pizza . . . . . . . .
Sbarro. . . . . . . . . . . . . . . . . .
Schlotzsky’s Deli . . . . . . . . .
Smashburger . . . . . . . . . . . .
Sonic Drive-In. . . . . . . . . . . .
Starbucks . . . . . . . . . . . . . . .
Steak ’n Shake . . . . . . . . . . .
Subway. . . . . . . . . . . . . . . . .
Taco Bell. . . . . . . . . . . . . . . .
Taco John’s. . . . . . . . . . . . . .
Tim Hortons . . . . . . . . . . . . .
Tropical Smoothie Café. . . . .
Wendy’s . . . . . . . . . . . . . . . .
Whataburger. . . . . . . . . . . . .
White Castle . . . . . . . . . . . . .
Wienerschnitzel . . . . . . . . . .
Wing•Stop. . . . . . . . . . . . . . .
Zaxby’s . . . . . . . . . . . . . . . . .
You Personally:
at last
times/last
6 months
30 days
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
999
OTHER (Write In)
Who made the decision of where to go?
Yourself. . . . . . . . . . . . . . . . . 1
Other Adult . . . . . . . . . . . . . . 2
Child . . . . . . . . . . . . . . . . . . . 3
352-0
TOTAL:
................. RESTAURANTS:
Applebee’s . . . . . . . . . . . . . .
Baker’s Square . . . . . . . . . . .
Benihana . . . . . . . . . . . . . . .
Bertucci’s . . . . . . . . . . . . . . .
Big Boy . . . . . . . . . . . . . . . . .
BJ’s Restaurant &
Brewhouse . . . . . . . . . . . .
Black Angus Steakhouse . . .
Bob Evans Farms. . . . . . . . .
Bonefish Grill . . . . . . . . . . . .
Buffalo Wild Wings . . . . . . . .
California Pizza Kitchen . . . .
Carino’s Italian . . . . . . . . . . .
Carrabba’s Italian Grill . . . . .
The Cheesecake Factory . . .
Chevy’s. . . . . . . . . . . . . . . . .
Chili’s Grill & Bar . . . . . . . . .
CiCi’s Pizza . . . . . . . . . . . . .
Cracker Barrel . . . . . . . . . . .
Dave & Buster’s . . . . . . . . . .
Denny’s . . . . . . . . . . . . . . . .
El Torito . . . . . . . . . . . . . . . .
Famous Dave’s . . . . . . . . . . .
Friendly’s . . . . . . . . . . . . . . .
Golden Corral . . . . . . . . . . . .
Hard Rock Cafe . . . . . . . . . .
HomeTown Buffet . . . . . . . . .
Hooters. . . . . . . . . . . . . . . . .
Houlihan’s. . . . . . . . . . . . . . .
International House of
Pancakes (IHOP) . . . . . . .
Joe’s Crab Shack . . . . . . . . .
Logan’s Roadhouse . . . . . . .
Lone Star Steakhouse . . . . .
LongHorn Steakhouse . . . . .
Marie Callenders . . . . . . . . .
O’Charley’s. . . . . . . . . . . . . .
Old Country Buffet . . . . . . . .
Olive Garden . . . . . . . . . . . .
On The Border . . . . . . . . . . .
Outback Steakhouse . . . . . .
P.F. Chang’s . . . . . . . . . . . . .
Pei Wei Asian Diner . . . . . . .
Perkins . . . . . . . . . . . . . . . . .
Ponderosa . . . . . . . . . . . . . .
Red Lobster . . . . . . . . . . . . .
Red Robin . . . . . . . . . . . . . .
Romano’s Macaroni Grill . . .
Ruby Tuesday. . . . . . . . . . . .
Ruth’s Chris Steak House. . .
Ryan’s. . . . . . . . . . . . . . . . . .
Shoney’s. . . . . . . . . . . . . . . .
Sizzler . . . . . . . . . . . . . . . . .
Smokey Bones . . . . . . . . . . .
Texas Roadhouse . . . . . . . . .
T.G.I. Friday’s . . . . . . . . . . . .
Tony Roma’s . . . . . . . . . . . . .
Uno Chicago Grill . . . . . . . . .
Village Inn Restaurant . . . . .
Waffle House . . . . . . . . . . . .
You Personally:
at last
times/last
30 days
6 months
351
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
999
OTHER (Write In)
Who made the decision of where to go?
Yourself. . . . . . . . . . . . . . . . . 1
Other Adult . . . . . . . . . . . . . . 2
Child . . . . . . . . . . . . . . . . . . . 3
MORE ABOUT
RESTAURANTS
354-0
FAST FOOD & DRIVE-IN RESTAURANTS
What Meals:
Breakfast . . . . . . . . . . . . . . . Lunch . . . . . . . . . . . . . . . . . . Snacks . . . . . . . . . . . . . . . . . Supper/Dinner . . . . . . . . . . . What Days:
Weekdays. . . . . . . . . . . . . . . Weekends. . . . . . . . . . . . . . . How Ordered:
Eat-in . . . . . . . . . . . . . . . . . . Home Delivery . . . . . . . . . . . Take-Out: Drive-Thru . . . . . . Take-Out: Walk-In . . . . . . . . . FAMILY RESTAURANTS & STEAK HOUSES
What Meals:
353
Breakfast . . . . . . . . . . . . . . . Lunch . . . . . . . . . . . . . . . . . . Snacks . . . . . . . . . . . . . . . . . Supper/Dinner . . . . . . . . . . . What Days:
Weekdays. . . . . . . . . . . . . . . Weekends. . . . . . . . . . . . . . . How Ordered:
Eat-in . . . . . . . . . . . . . . . . . . Home Delivery . . . . . . . . . . . Take-Out . . . . . . . . . . . . . . . . FINE DINING RESTAURANTS
Any Visit . . . . . . . . . . . . . . . . OTHER RESTAURANTS
Any Visit . . . . . . . . . . . . . . . . 70
71
72
73
74
75
76
77
78
79
60
61
62
63
64
65
66
67
68
61Y
01
02
RESTAURANT
EXPENDITURES
61Z
How much did you spend at the following types of
restaurants in the last 30 days? (Write in amount)
Fast Food & Drive-In Restaurants . . $
01
Family Restaurants
& Steak Houses. . . . . . . . . . . . . $
02
Fine Dining Restaurants . . . . . . . . . . $
03
Other Restaurants . . . . . . . . . . . . . $
04
CAMPING, RECREATION ITEMS, THEME PARKS,
LUGGAGE AND VACATIONS
CAMPING
LUGGAGE
THEME PARKS
How many overnight camping trips did you
take in the last 12 months?
Total number of trips:
339-0
Number of Nights
Where did you camp?
Camped in Past Year
PUBLIC CAMPGROUNDS:
340
National Parks/Forests. . .
01
State Parks/Forests . . . . .
02
Other Publicly Owned
Campgrounds. . . . . . . . .
03
PRIVATE CAMPGROUNDS:
(Open to the public)
KOA Campgrounds . . . . .
Independently Owned
Campgrounds. . . . . . . . .
04
05
Your Household:
Bought
last 12
Owns months
CAMPING
EQUIPMENT
341
1
2
Air Mattress (Inflatable). . . . . . . . .
Backpack . . . . . . . . . . . . . . . . . . .
Beverage Containers . . . . . . . . . .
Compass . . . . . . . . . . . . . . . . . . .
Daypack . . . . . . . . . . . . . . . . . . . .
01
02
03
04
05
Sleeping Bag . . . . . . . . . . . . . . . .
Hunting Knife . . . . . . . . . . . . . . . .
Tent . . . . . . . . . . . . . . . . . . . . . . .
Cooler or Ice Chest
(under 24 quarts). . . . . . . . . . . .
Cooler or Ice Chest
(24 quarts & over) . . . . . . . . . . .
06
07
08
09
10
Camp Cookware. . . . . . . . . . . . . .
Lantern (gas) . . . . . . . . . . . . . . . .
Lantern (electric) . . . . . . . . . . . . .
Camp Stove . . . . . . . . . . . . . . . . .
Insulated Picnic Jug . . . . . . . . . . .
Waterproof/Breathable Apparel . .
11
12
13
14
15
16
Amount your household spent on
342-0
camping equipment, last 12 months:
$1-$49
$50-$99 $100-$199 $200 or more
1
2
3
4
RECREATION ITEMS/
VEHICLES/BOATS
Your Household:
Acquired
in last 12
Owns months
343
1
2
Outboard motor (under 25 HP). . .
Outboard motor (25-75 HP) . . . . .
Outboard motor (over 75 HP) . . . .
Inboard/outboard power boat
(sterndrive) . . . . . . . . . . . . . . . .
Power boat (under 16 ft.) . . . . . . .
Power boat (16 ft. +) . . . . . . . . . . .
Bass/Fishing Boat (under 16 ft.) . .
Bass/Fishing Boat (16 ft. +) . . . . .
Sailboat (under 16 ft.) . . . . . . . . . .
Sailboat (16 ft. +) . . . . . . . . . . . . .
01
02
03
04
05
06
07
08
09
10
Inflatable boat. . . . . . . . . . . . . . . .
Personal watercraft. . . . . . . . . . . .
Rowboat . . . . . . . . . . . . . . . . . . . .
Canoe. . . . . . . . . . . . . . . . . . . . . .
Kayak . . . . . . . . . . . . . . . . . . . . . .
11
12
13
14
15
Boat Trailer . . . . . . . . . . . . . . . . . .
Motorhome . . . . . . . . . . . . . . . . . .
Towable trailer camper . . . . . . . . .
Towable folding tent camper
(pop-up) . . . . . . . . . . . . . . . . . . .
Other camper/trailer . . . . . . . . . . .
Snowmobile . . . . . . . . . . . . . . . . .
16
17
18
19
20
21
Have you visited a theme park in the last
12 months?
Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
You Personally:
Number
bought
last 12
Own
months
355
344-0
If yes, which did you visit?
345-0
Adventure Island (Florida) . . . . . . . . . . . . .
Aquatica (California, Florida, Texas). . . . . .
Busch Gardens (Florida) . . . . . . . . . . . . . .
Busch Gardens (Virginia) . . . . . . . . . . . . . .
Carowinds (North Carolina) . . . . . . . . . . . .
1
2
3
4
5
Cedar Point (Ohio) . . . . . . . . . . . . . . . . . . .
Discovery Cove (Florida) . . . . . . . . . . . . . .
Disney’s California Adventure. . . . . . . . . . .
Disneyland (California) . . . . . . . . . . . . . . . .
Dollywood (Tennessee) . . . . . . . . . . . . . . .
6
7
8
9
0
346-0
Dorney Park & Wild Water Kingdom
(Pennsylvania) . . . . . . . . . . . . . . . . . . . . .
Great America (California) . . . . . . . . . . . . .
Great Wolf Lodge . . . . . . . . . . . . . . . . . . . .
Hershey Park (Pennsylvania) . . . . . . . . . . .
Kings Dominion (Virginia). . . . . . . . . . . . . .
1
2
3
4
5
King’s Island (Ohio) . . . . . . . . . . . . . . . . . .
Knott’s Berry Farm (California) . . . . . . . . . .
Legoland (California) . . . . . . . . . . . . . . . . .
Legoland (Florida) . . . . . . . . . . . . . . . . . . .
6
7
8
9
347-0
Sea World (California) . . . . . . . . . . . . . . . .
Sea World (Florida) . . . . . . . . . . . . . . . . . .
Sea World (Texas) . . . . . . . . . . . . . . . . . . .
Sesame Place (Pennsylvania) . . . . . . . . . .
Six Flags America (Maryland) . . . . . . . . . .
1
2
3
4
5
Six Flags Discovery Kingdom (California) .
Six Flags Fiesta (Texas) . . . . . . . . . . . . . . .
Six Flags Great Adventure (New Jersey) . .
Six Flags Great America (Illinois) . . . . . . . .
6
7
8
9
348-0
Six Flags Magic Mountain (California) . . . .
Six Flags New England (Massachusetts). .
Six Flags Over Georgia . . . . . . . . . . . . . . .
Six Flags Over Texas . . . . . . . . . . . . . . . . .
Six Flags St. Louis . . . . . . . . . . . . . . . . . . .
Other Six Flags . . . . . . . . . . . . . . . . . . . . .
Page 32
1
2
3
4
5
6
TOTAL:
................. TYPES:
Attache . . . . . . . . . . . . . . . . .
Duffel . . . . . . . . . . . . . . . . . .
Garment Bag . . . . . . . . . . . .
Pullman/Suitcase . . . . . . . . .
Shoulder Briefcase/Bag . . . .
Other . . . . . . . . . . . . . . . . . .
01
02
03
04
05
06
KINDS:
Hard side . . . . . . . . . . . . . . . Soft side . . . . . . . . . . . . . . . . 07
08
BRANDS:
American Tourister . . . . . . . .
Atlantic . . . . . . . . . . . . . . . . .
Coach . . . . . . . . . . . . . . . . . .
Delsey . . . . . . . . . . . . . . . . .
Hartmann . . . . . . . . . . . . . . .
09
10
11
12
13
High Sierra . . . . . . . . . . . . . .
Jansport . . . . . . . . . . . . . . . .
Lands’ End . . . . . . . . . . . . . .
Louis Vuitton . . . . . . . . . . . . .
Pierre Cardin . . . . . . . . . . . .
Rimowa . . . . . . . . . . . . . . . .
Samsonite . . . . . . . . . . . . . .
Skyway . . . . . . . . . . . . . . . . .
Travelpro . . . . . . . . . . . . . . . .
Tumi . . . . . . . . . . . . . . . . . . .
Vera Bradley . . . . . . . . . . . . .
Victorinox Swiss Army . . . . .
OTHER (Write In)
1
2
Disney’s Animal Kingdom . . . . . . . . . . . .
Disney’s Hollywood Studios . . . . . . . . . .
Epcot Center. . . . . . . . . . . . . . . . . . . . . .
Magic Kingdom. . . . . . . . . . . . . . . . . . . .
Typhoon Lagoon . . . . . . . . . . . . . . . . . . .
5
6
7
8
9
3
$1 - $49 . . . . . . . . . . . . . .
$50 - $99 . . . . . . . . . . . . . .
$100 - $199 . . . . . . . . . . . . .
$200 - $299 . . . . . . . . . . . . .
$300 + . . . . . . . . . . . . . . . . .
356-0
1
2
3
4
5
PASSPORT
Do you personally own a valid passport?
357-0
Yes . . . . . . . . . . . . . . . . . . . . 1
No. . . . . . . . . . . . . . . . . . . . . 2
FOREIGN VACATIONS
4
Water Country USA (Virginia). . . . . . . . . . . 0
Wet ’n Wild (Florida) . . . . . . . . . . . . . . . . . . X
Wisconsin Dells . . . . . . . . . . . . . . . . . . . . . Y
350-0
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Who made the decision to visit?
Yourself (Alone or with someone else) . . . . 2
Child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Someone Else . . . . . . . . . . . . . . . . . . . . . . 4
In total, on how many different days did you
visit all theme parks in the last 12 months?
226-0
Have you visited an indoor water park in the
last 12 months?
64S-0
Yes
1
14
15
16
17
18
19
20
21
22
23
24
25
999
Total amount spent for all pieces, last 12 months:
349-0
Universal Studios (California). . . . . . . . . . .
Universal Studios (Florida) . . . . . . . . . . . . .
Universal Studios Islands of Adventure
(Florida) . . . . . . . . . . . . . . . . . . . . . . . . . .
Walt Disney World (Florida):
Blizzard Beach . . . . . . . . . . . . . . . . . . . .
00
How much did you spend on foreign
vacations in the past 12 months:
358-0
Less than $1,000 . . . . . . . . .
$1,000 - $2,999 . . . . . . . . . .
$3,000 - $5,999 . . . . . . . . . .
$6,000 - $7,999. . . . . . . . . . .
$8,000 or more. . . . . . . . . . .
1
2
3
4
5
DOMESTIC
VACATIONS
How much did you spend on domestic
vacations in the past 12 months:
359-0
Less than $1,000 . . . . . . . . .
$1,000 - $1,499 . . . . . . . . . .
$1,500 - $1,999 . . . . . . . . . .
$2,000 - $2,999 . . . . . . . . . .
$3,000 - $4,999 . . . . . . . . . .
1
2
3
4
5
$5,000 - $6,999 . . . . . . . . . . 6
$7,000 or more . . . . . . . . . . . 7
Page 33
FOREIGN TRAVEL (INCLUDING ALASKA & HAWAII)
FOREIGN TRAVEL
(including Alaska &
Hawaii)
Did you personally take a trip outside the
United States or to Alaska or Hawaii in the
last 3 years? Yes 1 No 2
360-0
If yes, how many trips did you take? ____________________
361-0
ANSWER FOR EACH TRIP:
Last
Trip
Second
Last Trip
Year trip was taken:
362-0
376-0
2016 . . . . . . . . . . . . . . . . . . . . . . . . . .
1
1
2015 . . . . . . . . . . . . . . . . . . . . . . . . . .
2
2
2014 . . . . . . . . . . . . . . . . . . . . . . . . . .
3
3
2013 . . . . . . . . . . . . . . . . . . . . . . . . . .
4
4
Which countries or destinations did you visit on each trip?
Aruba . . . . . . . . . . . . . . . . . . . . . . . . .
Barbados . . . . . . . . . . . . . . . . . . . . . .
Bermuda. . . . . . . . . . . . . . . . . . . . . . .
Bahamas . . . . . . . . . . . . . . . . . . . . . .
Cayman Islands . . . . . . . . . . . . . . . . .
Dominican Republic . . . . . . . . . . . . . .
Jamaica . . . . . . . . . . . . . . . . . . . . . . .
Puerto Rico. . . . . . . . . . . . . . . . . . . . .
Virgin Islands . . . . . . . . . . . . . . . . . . .
Other Caribbean Islands . . . . . . . . . .
Alaska. . . . . . . . . . . . . . . . . . . . . . . . .
Hawaii. . . . . . . . . . . . . . . . . . . . . . . . .
Canada. . . . . . . . . . . . . . . . . . . . . . . .
Mexico . . . . . . . . . . . . . . . . . . . . . . . .
Central America . . . . . . . . . . . . . . . . .
South America . . . . . . . . . . . . . . . . . .
England . . . . . . . . . . . . . . . . . . . . . . .
Ireland . . . . . . . . . . . . . . . . . . . . . . . .
Scotland . . . . . . . . . . . . . . . . . . . . . . .
France . . . . . . . . . . . . . . . . . . . . . . . .
Germany . . . . . . . . . . . . . . . . . . . . . .
Austria . . . . . . . . . . . . . . . . . . . . . . . .
Switzerland. . . . . . . . . . . . . . . . . . . . .
Netherlands (Holland) . . . . . . . . . . . .
Scandinavia . . . . . . . . . . . . . . . . . . . .
Italy. . . . . . . . . . . . . . . . . . . . . . . . . . .
Spain/Portugal . . . . . . . . . . . . . . . . . .
Greece . . . . . . . . . . . . . . . . . . . . . . . .
Other Western European countries . .
Russia . . . . . . . . . . . . . . . . . . . . . . . .
Other
Trips
390-0
1
2
3
4
363-0
1
2
3
4
5
377-0
1
2
3
4
5
391-0
1
2
3
4
5
6
7
8
9
0
6
7
8
9
0
6
7
8
9
0
364-0
1
2
3
4
5
378-0
1
2
3
4
5
392-0
1
2
3
4
5
6
7
8
9
6
7
8
9
6
7
8
9
365-0
1
2
3
4
5
379-0
1
2
3
4
5
393-0
1
2
3
4
5
6
7
8
9
0
X
6
7
8
9
0
X
6
7
8
9
0
X
366-0
380-0
1
2
3
4
394-0
1
2
3
4
5
6
7
8
9
0
X
Y
5
6
7
8
9
0
X
Y
60H-0
1
2
3
4
5
60J-0
1
2
3
4
5
6
7
8
9
0
6
7
8
9
0
381-0
1
2
3
4
395-0
1
2
3
4
5
6
7
8
5
6
7
8
Eastern Europe . . . . . . . . . . . . . . . . .
1
Turkey. . . . . . . . . . . . . . . . . . . . . . . . .
2
Israel . . . . . . . . . . . . . . . . . . . . . . . . .
3
Other Middle East . . . . . . . . . . . . . . .
4
Japan . . . . . . . . . . . . . . . . . . . . . . . . .
5
China . . . . . . . . . . . . . . . . . . . . . . . . .
6
Hong Kong . . . . . . . . . . . . . . . . . . . . .
7
India . . . . . . . . . . . . . . . . . . . . . . . . . .
8
South-East Asia . . . . . . . . . . . . . . . . .
9
Other Asian countries. . . . . . . . . . . . .
0
Australia/New Zealand/South Pacific .
X
Africa . . . . . . . . . . . . . . . . . . . . . . . . .
Y
Reason for trip:
60G-0
Business (paid by firm). . . . . . . . . . . .
1
Honeymoon . . . . . . . . . . . . . . . . . . . .
2
Vacation . . . . . . . . . . . . . . . . . . . . . . .
3
Personal (not vacation). . . . . . . . . . . .
4
Business/vacation combined . . . . . . .
5
Who did you travel with?
Yourself (alone) . . . . . . . . . . . . . . . . .
6
Spouse or mate . . . . . . . . . . . . . . . . .
7
Child(ren) less than 18 years old . . . .
8
Friend(s) . . . . . . . . . . . . . . . . . . . . . . .
9
Other . . . . . . . . . . . . . . . . . . . . . . . . .
0
Did you use the service of a Travel Agent or
Internet travel site for each trip?
367-0
Yes, used travel agent . . . . . . . . . . . . . .
1
Yes, used airline-specific Internet site . .
2
Yes, used general Internet travel site . .
3
No. . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
If yes, for what purpose:
Flight Reservations. . . . . . . . . . . . . . .
5
Hotel Reservations . . . . . . . . . . . . . . .
6
Local Sightseeing. . . . . . . . . . . . . . . .
7
Entire Trip . . . . . . . . . . . . . . . . . . . . . .
8
FOREIGN TRAVEL
(including Alaska &
Hawaii) (Continued)
Last
Trip
Second
Last Trip
Other
Trips
1. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3-4 . . . . . . . . . . . . . . . . . . . . . . . . . . .
5-7 . . . . . . . . . . . . . . . . . . . . . . . . . . .
8-10 . . . . . . . . . . . . . . . . . . . . . . . . . .
368-0
1
2
3
4
5
382-0
1
2
3
4
5
396-0
1
2
3
4
5
11-14 . . . . . . . . . . . . . . . . . . . . . . . . . .
15-29 . . . . . . . . . . . . . . . . . . . . . . . . .
30 + . . . . . . . . . . . . . . . . . . . . . . . . . .
6
7
8
6
7
8
6
7
8
When was each trip taken?
January-March . . . . . . . . . . . . . . . . . .
April-June . . . . . . . . . . . . . . . . . . . . . .
July-September . . . . . . . . . . . . . . . . .
October-December . . . . . . . . . . . . . . .
369-0
1
2
3
4
383-0
1
2
3
4
397-0
1
2
3
4
Means of travel for each trip:
Bus . . . . . . . . . . . . . . . . . . . . . . . . . . .
Personal Vehicle . . . . . . . . . . . . . . . . .
Cruise Ship. . . . . . . . . . . . . . . . . . . . .
Plane (charter/private) . . . . . . . . . . . .
Plane (scheduled flight) . . . . . . . . . . .
Railroad/Train . . . . . . . . . . . . . . . . . . .
Rental Vehicle. . . . . . . . . . . . . . . . . . .
5
6
7
8
9
0
X
5
6
7
8
9
0
X
5
6
7
8
9
0
X
Number of nights away on trip:
If by airplane, which airlines did you use during each trip?
Aer Lingus . . . . . . . . . . . . . . . . . . . . .
AeroMexico. . . . . . . . . . . . . . . . . . . . .
Air Canada . . . . . . . . . . . . . . . . . . . . .
Air France. . . . . . . . . . . . . . . . . . . . . .
Alaska Airlines . . . . . . . . . . . . . . . . . .
Alitalia. . . . . . . . . . . . . . . . . . . . . . . . .
American/American Eagle . . . . . . . . .
British Airways . . . . . . . . . . . . . . . . . .
Caribbean Airlines . . . . . . . . . . . . . . .
Delta. . . . . . . . . . . . . . . . . . . . . . . . . .
JetBlue . . . . . . . . . . . . . . . . . . . . . . . .
KLM . . . . . . . . . . . . . . . . . . . . . . . . . .
Lufthansa . . . . . . . . . . . . . . . . . . . . . .
United . . . . . . . . . . . . . . . . . . . . . . . . .
370-0
1
2
3
4
5
384-0
1
2
3
4
5
398-0
1
2
3
4
5
6
7
8
9
6
7
8
9
6
7
8
9
371-0
1
2
3
4
5
385-0
1
2
3
4
5
399-0
1
2
3
4
5
372-0
386-0
400-0
1
2
3
4
5
6
US Airways . . . . . . . . . . . . . . . . . . . . .
1
1
Virgin Atlantic . . . . . . . . . . . . . . . . . . .
2
2
Other Asia/Pacific based airline . . . . .
3
3
Other European based airline . . . . . .
4
4
Other Latin American based airline . .
5
5
Other . . . . . . . . . . . . . . . . . . . . . . . . .
6
6
For each airplane trip what did you fly?
373-0
387-0
First Class . . . . . . . . . . . . . . . . . . . . .
1
1
Business. . . . . . . . . . . . . . . . . . . . . . .
2
2
Coach . . . . . . . . . . . . . . . . . . . . . . . . .
3
3
For each airplane trip, did you use any in-flight
entertainment on the plane?
374-0
388-0
Listened to radio. . . . . . . . . . . . . . . . .
1
1
Watched movie/ Used in-flight
video equipment . . . . . . . . . . . . . . .
2
2
Read in-flight publication . . . . . . . . . .
3
3
Used Wi-Fi . . . . . . . . . . . . . . . . . . . . .
4
4
For each airplane trip, did you view CNN Airport Network
television in the airport?
Yes . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
5
Was this trip taken on an all inclusive travel package?
Yes . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
6
For vacation or honeymoon trips only:
What activities did you do on each vacation trip?
Attend a specific event . . . . . . . . . . . .
Fine dining . . . . . . . . . . . . . . . . . . . . .
General sightseeing . . . . . . . . . . . . . .
Go to beach . . . . . . . . . . . . . . . . . . . .
Play golf . . . . . . . . . . . . . . . . . . . . . . .
Running/Jogging . . . . . . . . . . . . . . . .
Sailing. . . . . . . . . . . . . . . . . . . . . . . . .
Scuba diving. . . . . . . . . . . . . . . . . . . .
Shopping . . . . . . . . . . . . . . . . . . . . . .
Skiing (cross country/downhill). . . . . .
Other outdoor sports or recreation . . .
Visit relatives or friends . . . . . . . . . . .
Visit cultural/historical site . . . . . . . . .
401-0
1
2
3
402-0
1
2
3
4
5
6
375-0
1
2
3
4
5
389-0
1
2
3
4
5
403-0
1
2
3
4
5
476-0
1
477-0
1
478-0
1
6
7
8
9
0
X
Y
6
7
8
9
0
X
Y
6
7
8
9
0
X
Y
DOMESTIC TRAVEL
DOMESTIC TRAVEL
Page 34
Have you personally made any trips of more
than one day’s duration in the past 12
months, within the continental U.S., including
business, vacation and weekend travel?
Yes 1 No 2
404-0
If yes, how many such trips have you made in the last
12 months.
________________ 405-0
ANSWER FOR EACH TRIP:
Last
Trip
Second
Last Trip
Other
Trips
406-0
1
2
3
4
5
6
7
419-0
1
2
3
4
5
6
7
432-0
1
2
3
4
5
6
7
Number of nights away on each trip:
1. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3-4 . . . . . . . . . . . . . . . . . . . . . . . . . . .
5-6 . . . . . . . . . . . . . . . . . . . . . . . . . . .
7-8. . . . . . . . . . . . . . . . . . . . . . . . . . . .
9-14 . . . . . . . . . . . . . . . . . . . . . . . . . .
15 + . . . . . . . . . . . . . . . . . . . . . . . . . .
Number of household members,
including yourself, on each trip:
Write in #
Write in #
Write in #
407-0
420-0
433-0
408-0
1
421-0
1
434-0
1
2
3
4
2
3
4
2
3
4
5
6
7
8
9
0
X
Y
5
6
7
8
9
0
X
Y
5
6
7
8
9
0
X
Y
409-0
1
2
3
4
5
422-0
1
2
3
4
5
435-0
1
2
3
4
5
6
7
8
9
0
X
Y
6
7
8
9
0
X
Y
6
7
8
9
0
X
Y
410-0
1
2
3
4
5
6
423-0
1
2
3
4
5
6
436-0
1
2
3
4
5
6
7
8
9
0
X
7
8
9
0
X
7
8
9
0
X
Which states did you visit on each trip?
Maine, New Hampshire, Vermont . . . .
Massachusetts, Connecticut,
Rhode Island . . . . . . . . . . . . . . . . .
New York . . . . . . . . . . . . . . . . . . . . . .
Pennsylvania, New Jersey. . . . . . . . . .
Delaware, Maryland, District of
Columbia. . . . . . . . . . . . . . . . . . . . .
Michigan, Wisconsin. . . . . . . . . . . . . .
Ohio, Indiana, Illinois . . . . . . . . . . . . .
Nebraska, Kansas . . . . . . . . . . . . . . .
N. Dakota, S. Dakota, Minnesota . . . .
Iowa, Missouri . . . . . . . . . . . . . . . . . .
N. Carolina, S. Carolina . . . . . . . . . . .
Alabama, Georgia . . . . . . . . . . . . . . .
Florida . . . . . . . . . . . . . . . . . . . . . . . .
Kentucky, Tennessee . . . . . . . . . . . . .
Mississippi, Louisiana . . . . . . . . . . . .
Texas . . . . . . . . . . . . . . . . . . . . . . . . .
Arkansas, Oklahoma . . . . . . . . . . . . .
Virginia, West Virginia. . . . . . . . . . . . .
Montana, Idaho, Wyoming . . . . . . . . .
Washington, Oregon. . . . . . . . . . . . . .
California . . . . . . . . . . . . . . . . . . . . . .
Utah, Colorado . . . . . . . . . . . . . . . . . .
Arizona, New Mexico . . . . . . . . . . . . .
Nevada . . . . . . . . . . . . . . . . . . . . . . .
Reason for each trip:
Business (paid for by company) . . . . .
Business (paid for by self) . . . . . . . . .
Honeymoon . . . . . . . . . . . . . . . . . . . .
Vacation . . . . . . . . . . . . . . . . . . . . . . .
Personal (not vacation). . . . . . . . . . . .
Part business/Part vacation . . . . . . . .
Who did you travel with?
Yourself (alone) . . . . . . . . . . . . . . . . .
Spouse or mate . . . . . . . . . . . . . . . . .
Child(ren) less than 18 years old . . . .
Friend(s) . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . .
DOMESTIC TRAVEL
(Continued)
424-0
1
2
3
437-0
1
2
3
Who decided upon the destination of each trip?
Yourself (alone or with someone else)
4
Travel Agent . . . . . . . . . . . . . . . . . . . .
5
Spouse or Mate . . . . . . . . . . . . . . . . .
6
4
5
6
4
5
6
Under 500 . . . . . . . . . . . . . . . . . . . . .
500-999 . . . . . . . . . . . . . . . . . . . . . . .
1000 + . . . . . . . . . . . . . . . . . . . . . . . .
Second
Last Trip
Other
Trips
Did you use the service of a Travel Agent or Internet travel site for each trip?
Yes, used travel agent . . . . . . . . . . . .
Yes, used airline-specific Internet site
Yes, used general Internet travel site .
No. . . . . . . . . . . . . . . . . . . . . . . . . . . .
413-0
1
2
3
4
426-0
1
2
3
4
439-0
1
2
3
4
If yes, for what purpose:
Flight Reservations. . . . . . . . . . . . . . .
Hotel Reservations . . . . . . . . . . . . . . .
Entire Trip . . . . . . . . . . . . . . . . . . . . . .
5
6
7
5
6
7
5
6
7
January – March. . . . . . . . . . . . . . . . .
April – June . . . . . . . . . . . . . . . . . . . .
July – September . . . . . . . . . . . . . . . .
October – December . . . . . . . . . . . . .
412-0
1
2
3
4
425-0
1
2
3
4
438-0
1
2
3
4
Means of Travel for each trip:
Plane (charter/private) . . . . . . . . . . . .
Plane (scheduled) . . . . . . . . . . . . . . .
Rental Vehicle. . . . . . . . . . . . . . . . . . .
Personal Vehicle . . . . . . . . . . . . . . . . .
Bus (charter or tour) . . . . . . . . . . . . . .
414-0
1
2
3
4
5
1
2
3
4
5
427-0
440-0
1
2
3
4
5
Bus (scheduled) . . . . . . . . . . . . . . . . .
Railroad/Train . . . . . . . . . . . . . . . . . . .
Motor Home/RV . . . . . . . . . . . . . . . . .
6
7
8
6
7
8
6
7
8
When was each trip taken?
If by plane, which airlines did you use during each trip?
AirTran Airways. . . . . . . . . . . . . . . . . .
Alaska Airlines . . . . . . . . . . . . . . . . . .
American/American Eagle . . . . . . . . .
Delta. . . . . . . . . . . . . . . . . . . . . . . . . .
Frontier . . . . . . . . . . . . . . . . . . . . . . . .
JetBlue . . . . . . . . . . . . . . . . . . . . . . . .
415-0
1
2
3
4
5
6
428-0
1
2
3
4
5
6
441-0
1
2
3
4
5
6
Southwest . . . . . . . . . . . . . . . . . . . . .
United . . . . . . . . . . . . . . . . . . . . . . . . .
US Airways . . . . . . . . . . . . . . . . . . . . .
Virgin America . . . . . . . . . . . . . . . . . .
Other _________________________
416-0
1
2
3
4
5
429-0
1
2
3
4
5
442-0
1
2
3
4
5
(Write In)
For each airplane trip, what did you fly?
First Class . . . . . . . . . . . . . . . . . . . . .
6
6
6
Business. . . . . . . . . . . . . . . . . . . . . . .
7
7
7
Coach . . . . . . . . . . . . . . . . . . . . . . . . .
8
8
8
For each trip, did you use any in-flight entertainment on the plane?
Listened to radio. . . . . . . . . . . . . . . . .
9
9
9
Watched movie/Used in-flight
video equipment . . . . . . . . . . . . . . .
0
0
0
Read in-flight publication . . . . . . . . . .
X
X
X
Used Wi-Fi . . . . . . . . . . . . . . . . . . . . .
Y
Y
Y
For each airplane trip, did you view CNN Airport Network
television in the airport?
445-0
446-0
1
447-0
1
417-0
1
2
3
4
5
430-0
1
2
3
4
5
443-0
1
2
3
4
5
6
7
6
7
6
7
418-0
1
2
3
4
5
431-0
1
2
3
4
5
444-0
1
2
3
4
5
6
7
8
9
0
X
6
7
8
9
0
X
6
7
8
9
0
X
Yes . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
For vacation or honeymoon trips only:
What activities did you do on each vacation trip?
Go to beach . . . . . . . . . . . . . . . . . . . .
General sightseeing . . . . . . . . . . . . . .
Attend a specific event . . . . . . . . . . . .
Shopping . . . . . . . . . . . . . . . . . . . . . .
Fine dining . . . . . . . . . . . . . . . . . . . . .
Play tennis . . . . . . . . . . . . . . . . . . . . .
Visit National Park . . . . . . . . . . . . . . .
Number of miles traveled from home (round trip) for each trip:
411-0
1
2
3
Last
Trip
Play golf . . . . . . . . . . . . . . . . . . . . . . .
Backpacking/Hiking . . . . . . . . . . . . . .
Bicycle riding . . . . . . . . . . . . . . . . . . .
Fishing . . . . . . . . . . . . . . . . . . . . . . . .
Hunting. . . . . . . . . . . . . . . . . . . . . . . .
Running/Jogging . . . . . . . . . . . . . . . .
Skiing (cross country/downhill). . . . . .
Other outdoor sports or recreation . . .
Visit relatives or friends . . . . . . . . . . .
Visit a health spa/retreat. . . . . . . . . . .
Visit cultural/historical site . . . . . . . . .
Page 35
HOTELS, MOTELS
& OTHER LODGING
HOTELS & MOTELS, PLANE TRIPS,
FREQUENT FLYER, CRUISE SHIPS & TRAVEL PLANNING
You Personally:
Stayed
Stayed
in for
in for
Personal/
Business Vacation
Number of nights spent in
a hotel, motel or other paid
lodging last 12 months:
448-0
1 ......................
1
2 ......................
2
3-4 . . . . . . . . . . . . . . . . . . . . .
3
5-7 . . . . . . . . . . . . . . . . . . . . .
4
8-10 . . . . . . . . . . . . . . . . . . . .
5
11-14 . . . . . . . . . . . . . . . . . . .
6
15 + . . . . . . . . . . . . . . . . . . . .
7
Hotel or Motel stayed at, last 12 months:
Americas Best Value Inn . . . .
Baymont Inns & Suites . . . . .
Best Western. . . . . . . . . . . . .
Clarion. . . . . . . . . . . . . . . . . .
Comfort Inn . . . . . . . . . . . . . .
Comfort Suites . . . . . . . . . . .
Country Inns & Suites . . . . . .
Courtyard (by Marriott) . . . . .
Crowne Plaza . . . . . . . . . . . .
Days Inn . . . . . . . . . . . . . . . .
DoubleTree . . . . . . . . . . . . . .
Econo Lodge . . . . . . . . . . . . .
Embassy Suites. . . . . . . . . . .
Fairfield Inn (by Marriott). . . .
Four Seasons . . . . . . . . . . . .
Great Wolf Lodge . . . . . . . . .
Hampton Inn . . . . . . . . . . . . .
Hilton . . . . . . . . . . . . . . . . . . .
Hilton Garden Inn . . . . . . . . .
Holiday Inn . . . . . . . . . . . . . .
Holiday Inn Express . . . . . . .
Homewood Suites (by Hilton)
Howard Johnson . . . . . . . . . .
Hyatt . . . . . . . . . . . . . . . . . . .
InterContinental Hotels . . . . .
La Quinta Inns & Suites . . . .
Marriott Hotels, Resorts and
Suites. . . . . . . . . . . . . . . . .
Microtel . . . . . . . . . . . . . . . . .
Motel 6 . . . . . . . . . . . . . . . . .
Omni . . . . . . . . . . . . . . . . . . .
Quality Inn. . . . . . . . . . . . . . .
Radisson . . . . . . . . . . . . . . . .
Ramada. . . . . . . . . . . . . . . . .
Red Roof Inn . . . . . . . . . . . . .
Renaissance . . . . . . . . . . . . .
Residence Inn (by Marriott). .
Ritz-Carlton . . . . . . . . . . . . . .
Sandals/Beaches . . . . . . . . .
Sheraton . . . . . . . . . . . . . . . .
Sleep Inn . . . . . . . . . . . . . . . .
SpringHill Suites (by Marriott)
Super 8 . . . . . . . . . . . . . . . . .
Travelodge. . . . . . . . . . . . . . .
W Hotel . . . . . . . . . . . . . . . . .
Westin . . . . . . . . . . . . . . . . . .
Wyndham . . . . . . . . . . . . . . .
453-0
1
2
3
4
5
6
7
454-0
1
2
3
4
5
6
7
8
9
0
X
Y
6
7
8
9
0
X
Y
450-0
1
2
3
4
5
455-0
1
2
3
4
5
6
7
8
9
0
X
6
7
8
9
0
X
451-0
1
2
3
456-0
1
2
3
4
5
6
7
8
9
0
X
Y
4
5
6
7
8
9
0
X
Y
452-0
1
2
3
4
5
457-0
1
2
3
4
5
6
7
8
9
0
X
6
7
8
9
0
X
60K-0
60L-0
Other hotel/motel (chain). . . .
1
1
Other hotel/motel (non-chain)
2
2
Bed and Breakfast. . . . . . . . .
3
3
Other . . . . . . . . . . . . . . . . . . .
4
4
“By owner” rental service used, last 12 months:
60Y-0
TRAVEL PLANNING
How many round trips BY PLANE, if any, have
you made in the last 12 months?
449-0
1
2
3
4
5
Airbnb . . . . . . . . . . . . . . . . . .
1
HomeAway . . . . . . . . . . . . . .
2
VRBO . . . . . . . . . . . . . . . . . .
3
Other . . . . . . . . . . . . . . . . . . .
4
Who generally makes your reservations?
Self . . . . . . . . . . . . . . . . . . . .
5
Other Family Member . . . . . .
6
Administrative Assistant . . . .
7
Travel Agent. . . . . . . . . . . . . .
8
Other . . . . . . . . . . . . . . . . . . .
9
ROUND TRIPS
BY PLANE
60Z-0
1
2
3
4
5
6
7
8
9
Number of trips made for:
Vacation/
Personal/
Honeymoon
Business
How many of these were:
Within the
continental U.S.
60M
60V
01
(Write in Number)
Outside the
continental U.S.
(Write in Number)
02
(Write in Number)
(Write in Number)
FREQUENT FLYER
Are you a member of a frequent flyer program?
458-0 Yes 1 No 2
If yes, which program(s) are you a member of?5
60TRegular
member
1
Elite
member
2
American AAdvantage. . . . . . . .
Delta SkyMiles. . . . . . . . . . . . . .
JetBlue TrueBlue . . . . . . . . . . . .
Southwest Rapid Rewards . . . .
United MileagePlus . . . . . . . . . .
01
02
03
04
05
Other . . . . . . . . . . . . . . . . . . . . .
06
Have you redeemed any frequent flyer miles in
the last 12 months? Yes 1 60U-0
HOTEL REWARDS
PROGRAMS
Are you currently enrolled in any hotel
rewards programs? Yes 1 No 2
65L-0
If yes, which program(s) are you a member of?
Hilton HHonors . . . . . . . . . . . . . . . . . .
Hyatt Gold Passport . . . . . . . . . . . . . .
IHG Priority Club . . . . . . . . . . . . . . . . .
Marriott Rewards . . . . . . . . . . . . . . . . .
Starwood Preferred Guest . . . . . . . . . .
3
4
5
6
7
Wyndham Rewards . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . .
8
9
takenCRUISE
a cruise SHIPS
of
Have you personally taken a cruise of more than
one day’s duration in the past three years?
459-0
Yes 1 No 2
Which of the following cruise lines did you
use in the past 3 years?
460-0
Carnival . . . . . . . . . . . . . . . . . . . . . . . .
1
Celebrity . . . . . . . . . . . . . . . . . . . . . . .
2
Disney Cruise Line . . . . . . . . . . . . . . .
3
Holland America Line . . . . . . . . . . . . .
4
Norwegian . . . . . . . . . . . . . . . . . . . . . .
5
Princess. . . . . . . . . . . . . . . . . . . . . . . .
Royal Caribbean . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . .
6
7
8
How many cruises have you taken in the past
461-0
three years?
(Write in Number)
Whether or not you made a purchase, in the last
12 months, which, if any, of these did you use for
ADVICE regarding fares & travel arrangements or
sightseeing & activities for an overnight trip?
You personally
obtained advice about:
Fares/Travel
Sightseeing/
arrangements,
Activities,
last 12 months last 12 months
Advised by:
Travel Agent. . . . . . . . .
Travel guidebook . . . . .
Travel magazine . . . . .
Other magazine. . . . . .
Newspaper . . . . . . . . .
60N-0
60Q-0
1
2
3
4
5
1
2
3
4
5
TV . . . . . . . . . . . . . . . .
Radio. . . . . . . . . . . . . .
Friends/Family
Recommendations . .
6
7
6
7
8
8
60P-0
60R-0
Airbnb.com . . . . . . . . .
Booking.com . . . . . . . .
Expedia.com . . . . . . . .
HomeAway.com. . . . . .
Hotels.com . . . . . . . . .
1
2
3
4
5
1
2
3
4
5
Hotwire.com . . . . . . . .
Kayak.com . . . . . . . . .
Orbitz.com. . . . . . . . . .
Priceline.com. . . . . . . .
Travelocity.com . . . . . .
6
7
8
9
0
6
7
8
9
0
Travelzoo.com . . . . . . .
TripAdvisor.com. . . . . .
X
Y
X
Y
60W-0
60X-0
1
2
1
2
3
4
5
3
4
5
VRBO.com . . . . . . . . .
Yahoo! Travel . . . . . . . .
Other general Internet
travel site . . . . . . . . .
Other Internet site . . . .
Other . . . . . . . . . . . . . .
How long before traveling do you typically
60S-0
book your trips?
More than 6 months before traveling. . . 1
3-6 months before traveling. . . . . . . . . . 2
Less than 3 months, but more
than 1 week before traveling . . . . . . . 3
1 week or less before traveling . . . . . . . 4
INTERNET AND CATALOG SHOPPING
INTERNET AND
CATALOG SHOPPING
By phone/
By
mail
Internet
last 12 last 12
months months
Items personally ordered, last 12 months:
Airline tickets . . . . . . . . . . . . . . . . . .
Automotive Products . . . . . . . . . . . .
Baby Accessories . . . . . . . . . . . . . .
Banking Services . . . . . . . . . . . . . .
Bedding/Linens . . . . . . . . . . . . . . . .
Books . . . . . . . . . . . . . . . . . . . . . . .
Cameras and equipment. . . . . . . . .
Car/Vehicle Rental Reservations . .
CDs . . . . . . . . . . . . . . . . . . . . . . . . .
Cell phones/accessories . . . . . . . . .
Clothing/Apparel . . . . . . . . . . . . . . .
Coffee & Tea . . . . . . . . . . . . . . . . . .
Collector’s items (coins, stamps,
etc.) . . . . . . . . . . . . . . . . . . . . . .
Computers . . . . . . . . . . . . . . . . . . .
Computer Software/Accessories . . .
Cooking/Kitchen accessories . . . . .
Cosmetics/toiletries . . . . . . . . . . . . .
Credit Cards . . . . . . . . . . . . . . . . . .
DVDs/Blu-ray Discs . . . . . . . . . . . . .
Educational Programs . . . . . . . . . . .
Fitness Apparel/Equipment . . . . . . .
Flowers . . . . . . . . . . . . . . . . . . . . . .
Food/Groceries . . . . . . . . . . . . . . . .
Garden supplies . . . . . . . . . . . . . . .
$1 - $49 . . .
$50 - $99 . .
$100 - $199
$200 - $499
$500 - $799
$800+ . . . .
6
7
8
9
0
X
Y
6
7
8
9
0
X
Y
463-0
469-0
464-0
1
2
3
4
5
470-0
1
2
3
4
5
6
7
8
6
7
8
9
0
X
Y
9
0
X
Y
465-0
1
2
3
4
5
471-0
1
2
3
4
5
6
7
6
7
8
9
0
X
Y
8
9
0
X
Y
466-0
1
2
3
4
5
472-0
1
2
3
4
5
6
7
8
9
6
7
8
9
Mail/Phone
Internet
467-0
1
2
3
4
5
6
473-0
1
2
3
4
5
6
Video Games/Systems . . . . . . . . . .
Vitamins . . . . . . . . . . . . . . . . . . . . .
Wedding/Occasion Gifts . . . . . . . . .
Wines/Champagnes . . . . . . . . . . . .
Other Electronics . . . . . . . . . . . . . .
Other Financial/Insurance Products
Other Health/Medical Supplies . . . .
Other Travel Services . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . .
Amount spent, last 12 months:
468-0
1
2
3
4
5
1
2
3
4
5
6
7
8
9
0
X
Y
Pet products/supplies . . . . . . . . . . .
Prescription Drugs . . . . . . . . . . . . .
Religious Products . . . . . . . . . . . . .
Shoes/Footwear . . . . . . . . . . . . . . .
Sports apparel/memorabilia . . . . . .
Sports equipment . . . . . . . . . . . . . .
Stereo/Audio Equipment . . . . . . . . .
Tickets – Concerts, shows,
other entertainment . . . . . . . . . . .
Tickets – Movies . . . . . . . . . . . . . . .
Tickets – Sports Events . . . . . . . . .
Toys/Games . . . . . . . . . . . . . . . . .
TVs . . . . . . . . . . . . . . . . . . . . . . . .
.................
.................
.................
.................
.................
.................
You Personally Ordered:
By Catalog By Internet
(phone/mail) (Website)
last 12
last 12
months
months
Catalogs or Websites ordered from:
462-0
1
2
3
4
5
1
2
3
4
5
6
7
8
9
0
X
Y
Gift Baskets . . . . . . . . . . . . . . . . . . .
Handbags/Other Accessories . . . . .
Hobby or craft supplies . . . . . . . . . .
Home furnishings . . . . . . . . . . . . . .
Home improvement items/tools. . . .
Hotel reservations . . . . . . . . . . . . . .
Household/small appliances . . . . . .
Housewares . . . . . . . . . . . . . . . . . .
Hunting, fishing, camping
equipment . . . . . . . . . . . . . . . . . .
Jewelry/watches . . . . . . . . . . . . . . .
MP3 Players . . . . . . . . . . . . . . . . . .
Office Supplies . . . . . . . . . . . . . . . .
INTERNET AND
CATALOG SHOPPING
(Continued)
Page 36
INTERNET AND
CATALOG SHOPPING
(Continued)
Websites personally ordered from, last 12 months:
65U-0
65N-0
65Q-0
1800PetMeds . . . . . . . . . . .
Avon . . . . . . . . . . . . . . . . . .
Coldwater Creek . . . . . . . . .
Crate & Barrel . . . . . . . . . . .
Eddie Bauer . . . . . . . . . . . .
1
2
3
4
5
1
2
3
4
5
1800flowers.com . . . . . . . . . . . . . . . . . . . . .
Amazon.com . . . . . . . . . . . . . . . . . . . . . . . .
American Eagle Outfitters (ae.com) . . . . . .
Apple.com . . . . . . . . . . . . . . . . . . . . . . . . . .
BananaRepublic.com . . . . . . . . . . . . . . . . .
1
2
3
4
5
Fingerhut . . . . . . . . . . . . . . .
Hammacher Schlemmer . . .
6
7
6
7
Barnes&Noble.com . . . . . . . . . . . . . . . . . . .
BathandBodyWorks.com . . . . . . . . . . . . . .
BedBathandBeyond.com . . . . . . . . . . . . . .
Belk.com . . . . . . . . . . . . . . . . . . . . . . . . . .
BestBuy.com . . . . . . . . . . . . . . . . . . . . . . . .
Costco.com . . . . . . . . . . . . . . . . . . . . . . . . .
6
7
8
9
0
X
65P-0
65R-0
Home Shopping
Network (HSN) . . . . . . . .
J. Crew . . . . . . . . . . . . . . . .
JCPenney . . . . . . . . . . . . . .
L.L. Bean . . . . . . . . . . . . . . .
Lands’ End . . . . . . . . . . . . .
1
2
3
4
5
1
2
3
4
5
Macy’s . . . . . . . . . . . . . . . . .
Neiman Marcus . . . . . . . . . .
Nordstrom . . . . . . . . . . . . . .
Office Depot . . . . . . . . . . . .
Pottery Barn . . . . . . . . . . . .
ProFlowers . . . . . . . . . . . . .
6
7
8
9
0
X
6
7
8
9
0
X
65S-0
Publishers Clearing House .
QVC . . . . . . . . . . . . . . . . . .
REI . . . . . . . . . . . . . . . . . . .
Staples . . . . . . . . . . . . . . . .
Teleflora . . . . . . . . . . . . . . .
Victoria's Secret . . . . . . . . .
Other Department/Specialty
Store . . . . . . . . . . . . . . . .
Other Catalog or Mail Order
Service . . . . . . . . . . . . . .
65T-0
1
2
3
4
5
1
2
3
4
5
6
6
7
7
8
8
HOW YOU SHOP
474-0
In the past 30 days, when purchasing a product
or service, which, if any, of these have you done?
Obtained information from a catalog, then:
Purchased in-store . . . . . . . . . . . . . . . . .
Purchased by Internet (computer/laptop)
Purchased by Internet (mobile device) . .
Purchased by mail/phone call . . . . . . . . .
1
2
3
4
Obtained information from a website on a
computer/laptop, then:
5
6
7
8
Obtained information from a mobile
website/app, then:
Obtained information in store, then:
475-0
1
2
3
4
5
6
7
8
65V-0
CVS.com . . . . . . . . . . . . . . . . . . . . . . . . . . .
Dell.com . . . . . . . . . . . . . . . . . . . . . . . . . . .
Dillards.com . . . . . . . . . . . . . . . . . . . . . . . .
DisneyStore.com . . . . . . . . . . . . . . . . . . . . .
Drugstore.com . . . . . . . . . . . . . . . . . . . . . .
1
2
3
4
5
eBay.com . . . . . . . . . . . . . . . . . . . . . . . . . .
EdibleArrangements.com . . . . . . . . . . . . . .
Etsy.com . . . . . . . . . . . . . . . . . . . . . . . . . . .
Expedia.com . . . . . . . . . . . . . . . . . . . . . . . .
Fandango.com . . . . . . . . . . . . . . . . . . . . . .
6
7
8
9
0
FreshDirect.com . . . . . . . . . . . . . . . . . . . . .
FTD.com . . . . . . . . . . . . . . . . . . . . . . . . . . .
X
Y
65W-0
Gap.com . . . . . . . . . . . . . . . . . . . . . . . . . . .
HomeDepot.com . . . . . . . . . . . . . . . . . . . . .
Hotels.com . . . . . . . . . . . . . . . . . . . . . . . . .
Hotwire.com . . . . . . . . . . . . . . . . . . . . . . . .
HP.com . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
2
3
4
5
iTunes.com (Apple Store) . . . . . . . . . . . . . .
Joann.com . . . . . . . . . . . . . . . . . . . . . . . . .
Kmart.com . . . . . . . . . . . . . . . . . . . . . . . . .
Kohls.com . . . . . . . . . . . . . . . . . . . . . . . . . .
LiveNation.com . . . . . . . . . . . . . . . . . . . . . .
6
7
8
9
0
Lowes.com . . . . . . . . . . . . . . . . . . . . . . . . .
Michaels.com . . . . . . . . . . . . . . . . . . . . . . .
X
Y
65Z-0
Nike.com . . . . . . . . . . . . . . . . . . . . . . . . . . .
OldNavy.com . . . . . . . . . . . . . . . . . . . . . . . .
Orbitz.com . . . . . . . . . . . . . . . . . . . . . . . . .
Overstock.com . . . . . . . . . . . . . . . . . . . . . .
PacSun.com . . . . . . . . . . . . . . . . . . . . . . . .
1
2
3
4
5
Payless.com . . . . . . . . . . . . . . . . . . . . . . . .
PetSmart.com . . . . . . . . . . . . . . . . . . . . . . .
Priceline.com . . . . . . . . . . . . . . . . . . . . . . .
SamsClub.com . . . . . . . . . . . . . . . . . . . . . .
Sears.com . . . . . . . . . . . . . . . . . . . . . . . . . .
6
7
8
9
0
Sephora.com . . . . . . . . . . . . . . . . . . . . . . .
StubHub.com . . . . . . . . . . . . . . . . . . . . . . .
X
Y
65Y-0
TJMaxx.com . . . . . . . . . . . . . . . . . . . . . . . .
Target.com . . . . . . . . . . . . . . . . . . . . . . . . .
Ticketmaster.com . . . . . . . . . . . . . . . . . . . .
ToysRUs.com . . . . . . . . . . . . . . . . . . . . . . .
Travelocity.com . . . . . . . . . . . . . . . . . . . . . .
1
2
3
4
5
Walgreens.com . . . . . . . . . . . . . . . . . . . . . .
Walmart.com . . . . . . . . . . . . . . . . . . . . . . . .
Wayfair.com . . . . . . . . . . . . . . . . . . . . . . . .
Zappos.com . . . . . . . . . . . . . . . . . . . . . . . .
Zulily.com . . . . . . . . . . . . . . . . . . . . . . . . . .
Other Internet site . . . . . . . . . . . . . . . . . . . .
6
7
8
9
0
X
FINANCIAL & REAL ESTATE
Page 37
CREDIT/DEBIT
CARDS
You Personally:
Have
(in your
own name)
Used in
the last
12 months
CREDIT/DEBIT
CARDS (Continued)
For what purpose(s) do you use your credit card(s)?
487
Major Credit/Debit Cards
American Express Green . . . . . . . . . . . . . . . . . . .
American Express Gold. . . . . . . . . . . . . . . . . . . . .
American Express Platinum . . . . . . . . . . . . . . . . .
American Express Blue . . . . . . . . . . . . . . . . . . . . .
American Express OPEN: Small Business . . . . . .
Other American Express . . . . . . . . . . . . . . . . . . . .
Diners Club . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Discover. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
MasterCard Standard . . . . . . . . . . . . . . . . . . . . . .
MasterCard Gold . . . . . . . . . . . . . . . . . . . . . . . . . .
MasterCard Platinum. . . . . . . . . . . . . . . . . . . . . . .
MasterCard World/World Elite . . . . . . . . . . . . . . . .
MasterCard Debit Card . . . . . . . . . . . . . . . . . . . . .
MasterCard BusinessCard (Small Business) . . . .
Visa Regular/Classic . . . . . . . . . . . . . . . . . . . . . . .
Visa Gold. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Visa Platinum . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Visa Signature . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Visa Check Card (Debit) . . . . . . . . . . . . . . . . . . . .
Visa Business (Small Business) . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
Which bank(s) issued your credit/debit card(s)?
Bank of America . . . . . . . . . . . . . . . . . . . . . . . . . .
Capital One . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Chase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Citibank . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Citizens Bank . . . . . . . . . . . . . . . . . . . . . . . . . . . .
HSBC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
PNC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
TD Bank . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
USAA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
U.S. Bank. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Wells Fargo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
22
23
24
25
26
27
28
29
30
31
32
33
Rewards associated with your major credit/debit card(s)
Cash back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Airline miles. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Hotel or Car Rental awards . . . . . . . . . . . . . . . . . .
Gifts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Charitable contribution . . . . . . . . . . . . . . . . . . . . .
Gasoline discounts . . . . . . . . . . . . . . . . . . . . . . . .
Other retail discounts . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
34
35
36
37
38
39
40
41
Store Credit Cards (Affiliated/Together with a major credit card)
Department Store . . . . . . . . . . . . . . . . . . . . . . . . .
Discount Store. . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other Store . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
42
43
44
1
2
Store Credit Cards (Not Affiliated/Together with a major credit card)
Dillard’s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
45
JCPenney . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
46
Lord & Taylor . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
47
Macy’s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
48
Nordstrom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
49
Sears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
50
Target . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
51
Walmart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
52
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
53
_____________489-0 Debit Cards: _____________
(Write in Number)
62N-0
(Write in Number)
What is your average monthly expenditure for all credit/debit card
purchases?
Credit Cards: $ _____________490-0 Debit Cards: $ ____________
(Write in Amount)
62P-0
(Write in Amount)
Do you typically carry a balance on your credit card(s)?
Never or rarely . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Sometimes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Usually or always. . . . . . . . . . . . . . . . . . . . . . . . . .
2
On average, how often do you use a credit card for personal and for
business purchases each month?
62R-0
62S-0
Personal
Business
1
2
3
4
5
1
2
3
4
5
More than 20 times per month . . . . . . .
11-20 times per month . . . . . . . . . . . . . .
6-10 times per month. . . . . . . . . . . . . . .
1-5 times per month. . . . . . . . . . . . . . . .
Less than once a month . . . . . . . . . . . .
On average, how often do you use a debit card for personal and for
business purchases each month?
Personal
Business
6
7
8
9
0
6
7
8
9
0
More than 20 times per month . . . . . . .
11-20 times per month . . . . . . . . . . . . . .
6-10 times per month. . . . . . . . . . . . . . .
1-5 times per month. . . . . . . . . . . . . . . .
Less than once a month . . . . . . . . . . . .
You Personally or Jointly:
LOANS AND
MORTGAGES
Have
64H
Acquired
Last
12 months
1
2
Home Mortgage (1st) . . . . . . . . . . . . . . . . . . . . . .
2nd Mortgage (Home Equity Loan) . . . . . . . . . . . .
Mortgage Refinance/Consolidation Loan . . . . . . .
Auto Loan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Personal Loan for Education (Student Loan). . . . .
Personal Loan, not for Education . . . . . . . . . . . . .
Personal Line of Credit . . . . . . . . . . . . . . . . . . . . .
Home Equity Line of Credit . . . . . . . . . . . . . . . . . .
Loan from 401(k) or 403(b) . . . . . . . . . . . . . . . . . .
Small Business Loan. . . . . . . . . . . . . . . . . . . . . . .
Title Loan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
01
02
03
04
05
06
07
08
09
10
11
Have you personally taken a short-term loan from a payday loan/
cash-advance company in the last 12 months?
Yes 1
REAL ESTATE
665-0
Which of the following types of property
does your household own and which were
acquired in the last 12 months?
496
Owns
Acquired
Number
last 12 of properties
months
owned
(Write in number)
1
Vacation/Weekend Home . . . . . . . . . . . .
Farm . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Retirement Real Estate . . . . . . . . . . . . . .
Investment Real Estate . . . . . . . . . . . . . .
2
61A
01
02
03
04
Do you or does anyone in your household own a time share?
Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
486-0
Have you personally used a real estate agent in the last 12 months to:
497-0
How many credit/debit cards do you own?
Credit Cards:
488-0
1
Business . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Personal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
676-0
1
2
3
In the last 12 months, have you accepted a pre-approved credit offer?
Yes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
Sell a property . . . . . . . . . . . . . . . . . . . . . . . . . .
Buy a property . . . . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
2
3
If yes, which real estate agent(s) did you use?
Century 21. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Coldwell Banker. . . . . . . . . . . . . . . . . . . . . . . . . .
Keller Williams . . . . . . . . . . . . . . . . . . . . . . . . . . .
Prudential Real Estate . . . . . . . . . . . . . . . . . . . . .
Re/Max . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
498-0
1
2
3
4
5
6
Was the home you currently occupy:
Custom built. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Already built when you purchased it . . . . . . . . . . .
499-0
1
2
Was it constructed within the last 12 months?
Yes 3
No 4
Have you personally bought and then sold (“flipped”) a property, for
investment purposes only, in the last 12 months?
Yes 1
No 2
61C-0
FINANCIAL
BANKING &
FINANCIAL
SERVICES
Page 38
You Personally or Jointly:
Acquired
last 12
Have
months
Bank Accounts/Services:
Savings Account . . . . . . . . . . . . . . . . . . . . . . . . . .
Certificate of Deposit (CD) . . . . . . . . . . . . . . . . . .
Interest Checking Account. . . . . . . . . . . . . . . . . . .
Non-Interest Checking Account . . . . . . . . . . . . . . .
Money Market Account . . . . . . . . . . . . . . . . . . . . .
01
02
03
04
05
Overdraft Protection. . . . . . . . . . . . . . . . . . . . . . . .
Other Banking Services . . . . . . . . . . . . . . . . . . . .
Business Checking Account . . . . . . . . . . . . . . . . .
Other Small Business Banking Services. . . . . . . .
06
07
08
09
1
2
481
Banks or Financial Institutions you personally used, last 12 months:
664-0
Ally Bank . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Bank of America . . . . . . . . . . . . . . . . . . . . . . . . . .
BB&T (Branch Banking & Trust) . . . . . . . . . . . . . .
Capital One . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Chase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
2
3
4
5
Citibank . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Citizens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Fifth Third Bank . . . . . . . . . . . . . . . . . . . . . . . . . . .
HSBC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
KeyBank . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
7
8
9
0
PNC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Regions Bank . . . . . . . . . . . . . . . . . . . . . . . . . . . .
X
Y
64J-0
Sun Trust . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
TD Bank . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
U.S. Bank. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Wells Fargo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other National Bank . . . . . . . . . . . . . . . . . . . . . . .
1
2
3
4
5
Local/Community Bank . . . . . . . . . . . . . . . . . . . . .
Credit Union . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mutual Funds Co.. . . . . . . . . . . . . . . . . . . . . . . . . .
Internet Bank . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
7
8
9
Banking methods you personally used, last 12 months:
482-0
Bank in person . . . . . . . . . . . . . . . . . . . . . . . . . . .
ATM/Cash Machine . . . . . . . . . . . . . . . . . . . . . . . .
Bank by Mail . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Direct Deposit (payroll check) . . . . . . . . . . . . . . . .
Bank by Phone . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
2
3
4
5
Banking Online/Internet. . . . . . . . . . . . . . . . . . . . .
Banking on Mobile Device. . . . . . . . . . . . . . . . . . .
Paperless Statements . . . . . . . . . . . . . . . . . . . . . .
6
7
8
In the last 6 months have you done any of the following?
61B-0
Wired or sent money with:
MoneyGram . . . . . . . . . . . . . . . . . . . . . . . . . .
1
Western Union . . . . . . . . . . . . . . . . . . . . . . . .
2
Bank Wire Transfer . . . . . . . . . . . . . . . . . . . . .
3
U.S. Postal Service . . . . . . . . . . . . . . . . . . . . .
4
Overnight Courier . . . . . . . . . . . . . . . . . . . . . .
5
Another Way . . . . . . . . . . . . . . . . . . . . . . . . . .
6
Purchased a money order . . . . . . . . . . . . . . . . . . .
7
Used a check cashing service. . . . . . . . . . . . . . . .
8
Which, if any, of the following do you consider very
important when choosing a bank or financial institution?
63R-0
Customer Service . . . . . . . . . . . . . . . . . . . . . . . . .
Financial Stability of Company . . . . . . . . . . . . . . .
Friend’s/Relative’s Recommendation. . . . . . . . . . .
Interest Rates . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Location of Branch . . . . . . . . . . . . . . . . . . . . . . . .
1
2
3
4
5
Reputation of Company. . . . . . . . . . . . . . . . . . . . .
Reward Programs . . . . . . . . . . . . . . . . . . . . . . . . .
Size of Company . . . . . . . . . . . . . . . . . . . . . . . . . .
Years in Business . . . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
7
8
9
0
Did you choose to change from one bank to another in the last 12
months? Yes X
INVESTMENT
ACTIVITY
Have you used any of the following for
financial services or advice in the last
12 months?
Stock Rating Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Financial Planner/Certified Financial Planner (CFP) . . . . . . . .
Personal Money Manager . . . . . . . . . . . . . . . . . . . . . . . . . .
Financial Advisor/Broker . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Newspaper/Magazine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
TV or Radio show . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Internet site. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Friends/Family . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other Source . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
492-0
1
2
3
4
5
6
7
8
9
If you contacted a brokerage firm in the last 12 months, what was the
reason for the contact?
Discount
Brokerage
Firm
493
Advice or Price Quotes . . . . . . . . . . . . . . .
Purchased or Sold Bonds . . . . . . . . . . . . .
Purchased or Sold Stocks . . . . . . . . . . . . .
Purchased or Sold Mutual Funds . . . . . . .
Full Service Online
Brokerage Brokerage
Firm
Firm
1
01
02
03
04
2
3
Brokerage Firms or other financial institutions, used in last 12 months:
BNY Mellon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Capital One ShareBuilder . . . . . . . . . . . . . . . . . . .
Charles Schwab . . . . . . . . . . . . . . . . . . . . . . . . . .
Chase Investment Services. . . . . . . . . . . . . . . . . .
Edward Jones . . . . . . . . . . . . . . . . . . . . . . . . . . . .
E*Trade . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Fidelity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Merrill Lynch . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Morgan Stanley Smith Barney. . . . . . . . . . . . . . . .
Raymond James . . . . . . . . . . . . . . . . . . . . . . . . . .
Scottrade . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
T. Rowe Price. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
TD Ameritrade . . . . . . . . . . . . . . . . . . . . . . . . . . . .
TIAA-CREF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
UBS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
USAA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Vanguard Group . . . . . . . . . . . . . . . . . . . . . . . . . .
Wealthfront . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Wells Fargo Advisors . . . . . . . . . . . . . . . . . . . . . . .
494-0
1
2
3
4
5
6
7
8
9
495-0
1
2
3
4
5
6
7
8
9
0
64T-0
Other full service firm . . . . . . . . . . . . . . . . . . . . . .
1
Other discount brokerage firm. . . . . . . . . . . . . . . .
2
Other online brokerage firm. . . . . . . . . . . . . . . . . .
3
Other bank. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
Investment transactions (stocks, bonds, mutual funds) executed
in the past 12 months: (Please count each buy and sell separately.)
None. . . . . . . . . . . . 1
1-2 . . . . . . . . . . . . . 2
216-0
3-9 . . . . . . . . . . . . 3
10-19 . . . . . . . . . . 4
20-49 . . . . . . . . . 5
50+. . . . . . . . . . . 6
MUTUAL FUNDS
Do you invest in a mutual fund managed
by any of these mutual fund families/companies?
American Century . . . . . . . . . . . . . . . . . . . . . . . . .
American Funds . . . . . . . . . . . . . . . . . . . . . . . . . .
Charles Schwab/Schwab . . . . . . . . . . . . . . . . . . .
Dreyfus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
DWS Investments . . . . . . . . . . . . . . . . . . . . . . . . .
Fidelity Investments. . . . . . . . . . . . . . . . . . . . . . . .
Franklin Templeton . . . . . . . . . . . . . . . . . . . . . . . .
The Hartford . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Invesco . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Janus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Lord Abbett . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Merrill Lynch . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Morgan Stanley Smith Barney. . . . . . . . . . . . . . . .
Oppenheimer. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Prudential Investments . . . . . . . . . . . . . . . . . . . . .
Putnam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
TIAA-CREF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
T. Rowe Price. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
UBS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
USAA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Vanguard Group . . . . . . . . . . . . . . . . . . . . . . . . . .
Voya. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Own
1
Acquired or
added to
in last
12 months
700
2
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
FINANCIAL & INSURANCE
Page 39
LIFE INSURANCE
(Continued)
LIFE INSURANCE
Do you currently carry any life
insurance?
Yes 1
Which kind(s) do you carry?
Separate term policy . . . . . . . . . . . . . . .
Separate whole life policy . . . . . . . . . . .
Combination term/whole life policy . . . .
Universal life . . . . . . . . . . . . . . . . . . . . .
Variable life . . . . . . . . . . . . . . . . . . . . . .
504-0
508-0
1
2
3
4
5
How many different life insurance
policies do you carry?
507-0
Number of policies
How acquired:
505-0
From a union . . . . . . . . . . . . . . . . . . . . .
1
From a place of work . . . . . . . . . . . . . . .
2
From a fraternal or other membership
group. . . . . . . . . . . . . . . . . . . . . . . . . .
3
Veterans life insurance . . . . . . . . . . . . .
4
From a bank . . . . . . . . . . . . . . . . . . . . .
5
With loan, mortgage or installment
payments . . . . . . . . . . . . . . . . . . . . . .
Through an agent representing one
company . . . . . . . . . . . . . . . . . . . . . .
Through an agent (broker) representing
more than one company . . . . . . . . . .
In response to mail advertising
(no agent) . . . . . . . . . . . . . . . . . . . . .
Direct from insurance company via phone
(no agent) . . . . . . . . . . . . . . . . . . . . . . .
Direct from insurance company via website
(no agent). . . . . . . . . . . . . . . . . . . . . . . .
6
7
8
9
0
X
Total face value of all the life insurance
you currently carry:
Less than $20,000. . . . . . . . . . . . . . . . .
$ 20,000 - $ 49,999 . . . . . . . . . . . . . . .
$ 50,000 - $ 99,999 . . . . . . . . . . . . . . .
$100,000 - $149,999 . . . . . . . . . . . . . . .
$150,000 - $249,999 . . . . . . . . . . . . . . .
$250,000 - $499,999 . . . . . . . . . . . . . . .
$500,000 or more . . . . . . . . . . . . . . . . .
SECURITIES
506-0
1
2
3
4
5
6
7
Acquired
Last 12
Months
Have
Policy
1
509
2
With which company:
AAA . . . . . . . . . . . . . . . . . . . .
AARP from New York Life . . .
Aetna . . . . . . . . . . . . . . . . . . .
AFLAC. . . . . . . . . . . . . . . . . .
AIG American General . . . . .
Allstate. . . . . . . . . . . . . . . . . .
American Family . . . . . . . . . .
AXA Equitable . . . . . . . . . . . .
Bankers Life & Casualty . . . . .
Cigna . . . . . . . . . . . . . . . . . . .
Colonial Penn . . . . . . . . . . . .
Farm Bureau . . . . . . . . . . . . .
Farmers Insurance Group . . .
Genworth. . . . . . . . . . . . . . . .
Gerber Life . . . . . . . . . . . . . .
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
Guardian . . . . . . . . . . . . . . . .
The Hartford . . . . . . . . . . . . .
John Hancock . . . . . . . . . . . .
Lincoln Financial Group. . . . .
MassMutual . . . . . . . . . . . . . .
16
17
18
19
20
MetLife. . . . . . . . . . . . . . . . . .
Mutual of Omaha. . . . . . . . . .
Nationwide. . . . . . . . . . . . . . .
New York Life . . . . . . . . . . . . .
Northwestern Mutual . . . . . . .
21
22
23
24
25
Pacific Life . . . . . . . . . . . . . . .
Principal Financial Group . . .
Prudential . . . . . . . . . . . . . . .
SBLI. . . . . . . . . . . . . . . . . . . .
State Farm. . . . . . . . . . . . . . .
26
27
28
29
30
TIAA-CREF . . . . . . . . . . . . . .
Unum Group . . . . . . . . . . . . .
USAA. . . . . . . . . . . . . . . . . . .
Veterans Group Life
(VGLI) . . . . . . . . . . . . . . . . .
Voya. . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . .
31
32
33
34
35
36
Please mark the securities and/or retirement/college savings plans you
personally own. For each type owned, what is the approximate current
market value and was any part acquired in the last 12 months?
PAYING BILLS
Bill-paying methods you personally used,
last 12 months:
64M-0
Pay in person . . . . . . . . . . . . . . . . . . . . .
Pay by mail . . . . . . . . . . . . . . . . . . . . . . .
Pay by Internet/Online . . . . . . . . . . . . . .
Pay by phone using credit card . . . . . . .
Pay by mobile device . . . . . . . . . . . . . . .
1
2
3
4
5
Bills automatically charged to credit card
Bills automatically deducted from bank
account . . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
7
8
DIGITAL PAYMENT
SERVICES
Digital payment services you personally used
to make a purchase or payment, last 30 days:
510-0
Amazon Payments . . . . . . . . . . . . . . . . .
Android Pay . . . . . . . . . . . . . . . . . . . . . .
Apple Pay . . . . . . . . . . . . . . . . . . . . . . . .
Google Wallet . . . . . . . . . . . . . . . . . . . . .
MasterPass by MasterCard . . . . . . . . . .
1
2
3
4
5
PayPal . . . . . . . . . . . . . . . . . . . . . . . . . .
Samsung Pay . . . . . . . . . . . . . . . . . . . . .
Venmo . . . . . . . . . . . . . . . . . . . . . . . . . .
Visa Checkout . . . . . . . . . . . . . . . . . . . .
Other digital payment service. . . . . . . . .
6
7
8
9
0
TRAVELERS
CHEQUES
Have you personally bought travelers cheques
Yes 1 No 2
483-0
TOTAL VALUE OF HOLDINGS
Own
Under
$10,000
$10,000$49,999
$50,000$149,999
$150,000$249,999
$250,000
or more
Acquired
or added to
in last 12
months
1
2
3
4
5
6
7
01
02
03
04
05
06
07
08
09
10
Mutual Funds (Bonds) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mutual Funds (Stocks) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Tax Exempt Funds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Exchange Traded Funds (ETFs) . . . . . . . . . . . . . . . . . . . . . . . . . .
Annuities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Savings Certificates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Insured Money Market Accounts (Bank) . . . . . . . . . . . . . . . . . . . .
CD (Certificate(s) of Deposit)—6 months or less . . . . . . . . . . . . .
CD (Certificate(s) of Deposit)—more than 6 months. . . . . . . . . . .
Investments in Gold or other Precious Metals or Gems . . . . . . . .
11
12
13
14
15
16
17
18
19
20
Investment Collections of Antiques, Books, Stamps, etc. . . . . . . .
Other investments (Commodities/Puts/Calls, etc.) . . . . . . . . . . . .
21
22
Retirement or college savings plans you personally have:
Traditional IRA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Roth IRA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Keogh . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
401(k) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
403(b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
457(b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
529 Plan (College Savings Plan). . . . . . . . . . . . . . . . . . . . . . . . . .
23
24
25
26
27
28
29
500
Securities you personally own:
U.S. Savings Bonds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
U.S. Treasury Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other U.S. Government Bonds . . . . . . . . . . . . . . . . . . . . . . . . . . .
Common or Preferred Stock in Company you work for . . . . . . . . .
Common Stock in any other Company . . . . . . . . . . . . . . . . . . . . .
Preferred Stock in any other Company . . . . . . . . . . . . . . . . . . . . .
Privately held shares of Companies or Partnerships . . . . . . . . . .
City/Municipal or State Bonds . . . . . . . . . . . . . . . . . . . . . . . . . . .
Corporate Bonds or Debentures . . . . . . . . . . . . . . . . . . . . . . . . .
Money Market Funds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
2
3
4
5
6
7
FINANCIAL & INSURANCE
HOMEOWNERS OR
PERSONAL PROPERTY
INSURANCE
MEDICAL INSURANCE
Do you currently carry fire, theft or other type
of loss insurance on either your home or your
personal belongings?
511
Page 40
Your Household
Acquired
Currently
Last 12
Carries
Months
1
Homeowner . . . . . . . . . . . . . . Renter . . . . . . . . . . . . . . . . . . . Condominium/Co-op . . . . . . . With what company?
AAA . . . . . . . . . . . . . . . . . . . .
AIG . . . . . . . . . . . . . . . . . . . . .
Allstate . . . . . . . . . . . . . . . . . .
American Family . . . . . . . . . . .
Country . . . . . . . . . . . . . . . . . .
Encompass. . . . . . . . . . . . . . .
Esurance . . . . . . . . . . . . . . . .
Farmers Insurance Group . . .
Foremost . . . . . . . . . . . . . . . .
Geico . . . . . . . . . . . . . . . . . . .
The Hartford . . . . . . . . . . . . . .
Liberty Mutual. . . . . . . . . . . . .
MetLife . . . . . . . . . . . . . . . . . .
Nationwide . . . . . . . . . . . . . . .
Progressive . . . . . . . . . . . . . . .
Safeco . . . . . . . . . . . . . . . . . .
State Farm . . . . . . . . . . . . . . .
Travelers . . . . . . . . . . . . . . . . .
USAA . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . .
How was it acquired?
2
01
02
03
513-0
1
2
3
4
5
6
7
8
9
0
514-0
1
2
3
4
5
6
7
8
9
0
515-0
1
From an agent . . . . . . . . . . . .
In response to direct mail
advertising . . . . . . . . . . . . . . 2
company via phone . . . . . . . 3
company via website . . . . . . 4
Who decided which company to use?
516-0
someone else) . . . . . . . . . . 1
Someone else . . . . . . . . . . . . 2
Total value for loss covered by policies:
Less than $10,000 . . . . . . . . .
$110,000 - $224,999 . . . . . . . .
$125,000 - $249,999 . . . . . . .
$150,000 - $274,999. . . . . . . .
$175,000 - $299,999 . . . . . . .
$100,000 - $199,999 . . . . . . .
$200,000 - $299,999 . . . . . . .
$300,000 - $499,999 . . . . . . .
$500,000 or more . . . . . . . . . .
518-0
1
2
3
4
5
6
7
8
9
Floater policy(s) or additional coverage carried:
own name) and check
which cards you
in the last 12 months:
Are you personally covered by any medical,
hospital or accident insurance?
Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Who is covered by this insurance?
You and other household/family
members . . . . . . . . . . . . . . . . . . . . . . .
You alone . . . . . . . . . . . . . . . . . . . . . . . .
What type of polic(ies) do you have?
Non-Government
(e.g. Group, Individual, etc.) . . . . . . . . .
Medicaid . . . . . . . . . . . . . . . . . . . . . . . . .
Medicare. . . . . . . . . . . . . . . . . . . . . . . . .
With which company?
AARP . . . . . . . . . . . . . . . . . . . . . . . . . . .
Aetna . . . . . . . . . . . . . . . . . . . . . . . . . . .
AFLAC . . . . . . . . . . . . . . . . . . . . . . . . . .
Bankers Life & Casualty . . . . . . . . . . . . .
BlueCross/BlueShield. . . . . . . . . . . . . . .
Cigna . . . . . . . . . . . . . . . . . . . . . . . . . . .
Colonial Life . . . . . . . . . . . . . . . . . . . . . .
Health Net . . . . . . . . . . . . . . . . . . . . . . .
Humana . . . . . . . . . . . . . . . . . . . . . . . . .
Kaiser Permanente. . . . . . . . . . . . . . . . .
MetLife . . . . . . . . . . . . . . . . . . . . . . . . . .
Mutual of Omaha . . . . . . . . . . . . . . . . . .
Oxford . . . . . . . . . . . . . . . . . . . . . . . . . . .
State Farm . . . . . . . . . . . . . . . . . . . . . . .
United Healthcare . . . . . . . . . . . . . . . . . .
Unum . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . .
How was policy obtained?
From a union . . . . . . . . . . . . . . . . . . . . .
From a place of work . . . . . . . . . . . . . . .
From a fraternal or other membership
group . . . . . . . . . . . . . . . . . . . . . . . . . .
State or national healthcare exchange . .
Other government source. . . . . . . . . . . .
Through an agent representing one
company . . . . . . . . . . . . . . . . . . . . . . .
Through an agent (broker) representing
more than one company . . . . . . . . . . .
In response to mail advertising or phone
contact (no agent) . . . . . . . . . . . . . . . .
Through the Internet . . . . . . . . . . . . . . . .
What kind of policy is it?
EPO (Exclusive Provider Organization) .
HMO (Health Maintenance
Organization) . . . . . . . . . . . . . . . . . . . .
POS (Point-of-Service) . . . . . . . . . . . . . .
PPO (Preferred Provider Organization) .
Traditional Indemnity/Fee-for-Service . . .
Catastrophic/High Deductible . . . . . . . . .
Supplemental/Gap Insurance . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . .
Did you choose to change insurance
companies in the last 12 months?
Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
MORE ABOUT
INSURANCE
520-0
1
2
3
522-0
1
2
3
523-0
1
2
3
4
5
6
7
8
524-0
1
2
3
4
5
6
7
8
9
521-0
1
2
3
4
5
6
7
8
9
64K-0
1
2
3
4
5
6
7
8
Do you have a combined home and auto policy?
Yes . . . . . . . . . . . . . . . . . . . . . 6
Which of the following types of insurance do
you personally carry?
526-0
1
2
Delta Dental . . . . . . . . . . . . . . . . . . . . . .
Other dental . . . . . . . . . . . . . . . . . . . . . .
Disability/Loss of income through
medical causes . . . . . . . . . . . . . . . . . .
Prescription drugs. . . . . . . . . . . . . . . . . .
Vision care . . . . . . . . . . . . . . . . . . . . . . .
Accidental death and dismemberment . .
Boat owners . . . . . . . . . . . . . . . . . . . . . .
Identity theft . . . . . . . . . . . . . . . . . . . . . .
Long term care . . . . . . . . . . . . . . . . . . . .
Mortgage . . . . . . . . . . . . . . . . . . . . . . . .
Personal liability (not Automotive or
Homeowners) . . . . . . . . . . . . . . . . . . .
Small business . . . . . . . . . . . . . . . . . . . .
3
4
5
6
7
8
9
0
X
Y
517-0
1
Travel . . . . . . . . . . . . . . . . . . . . . . . . . . .
TAX PREPARATION
How were your personal federal income taxes
prepared in the last 12 months?
Prepared by:
64A-0
You, personally, manually . . . . . . . . . . . .
1
You, personally, using a computer software
program:
H&R Block . . . . . . . . . . . . . . . . . . .
TaxACT . . . . . . . . . . . . . . . . . . . . . .
TurboTax . . . . . . . . . . . . . . . . . . . . .
Other software . . . . . . . . . . . . . . . .
2
3
4
5
You, personally, using an Internet/online tax
preparation program or service:
H&R Block . . . . . . . . . . . . . . . . . . .
6
Jackson Hewitt Online. . . . . . . . . . .
7
Liberty Tax . . . . . . . . . . . . . . . . . . .
8
TaxACT . . . . . . . . . . . . . . . . . . . . . .
9
TurboTax . . . . . . . . . . . . . . . . . . . . .
0
Other online program/service . . . . .
X
64N-0
1
2
3
4
5
H&R Block (on-site) . . . . . . . . . . . . . . . .
Jackson Hewitt (on-site) . . . . . . . . . . . . .
Liberty Tax (on-site) . . . . . . . . . . . . . . . .
Other tax preparation service, on-site . . .
CPA or other tax professional . . . . . . . . .
Friend or family member . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
7
When filed, last 12 months:
Before IRS deadline . . . . . . . . . . . . . . . .
Same day of the IRS deadline . . . . . . . .
After the IRS deadline . . . . . . . . . . . . . . .
8
9
0
525-0
1
Which of the following, if any, are very important to you when
choosing an Insurance provider? (Check all that apply)
519-0
Floater for jewelry or furs . . . . 1
Floater for collections (antiques,
coins, etc.) . . . . . . . . . . . . . . 2
Floater for other personal
items . . . . . . . . . . . . . . . . . . 3
Coverage for earthquakes or
floods . . . . . . . . . . . . . . . . 4
Other additional coverage . . . 5
OTHER INSURANCE
64Z
Auto
Insurance
VERY IMPORTANT WHEN CHOOSING
Homeowners/
Personal Property
Life
Insurance
Insurance
Medical
Insurance
Agent Recommendation . . . . . . . . . . . . . .
Customer Service . . . . . . . . . . . . . . . . . . .
Financial Stability of Company . . . . . . . . .
Location. . . . . . . . . . . . . . . . . . . . . . . . . . .
Rates. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
01
02
03
04
05
Reputation of Company. . . . . . . . . . . . . . .
Simplicity of Application . . . . . . . . . . . . . .
Size of Company . . . . . . . . . . . . . . . . . . . .
Years in Business . . . . . . . . . . . . . . . . . . .
Customer Loyalty Program . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
06
07
08
09
10
11
1
2
3
4
APPAREL
Page 41
AMOUNT SPENT
IN TOTAL IN THE
LAST 12 MONTHS:
Under $50$75$50
$74
$149
$150 +
Pairs
purchased
in last 12
months
ATHLETIC SHOES
530
Aerobic/Fitness shoes . . .
Baseball/Softball shoes . .
Basketball shoes . . . . . . .
Boat/Deck shoes . . . . . . .
01
03
05
07
Cross Training shoes . . . .
Golf shoes . . . . . . . . . . . .
Hiking/Backpacking boots
Hunting Boots . . . . . . . . .
Running/Jogging shoes . .
09
11
13
15
17
Soccer shoes . . . . . . . . .
Sports Sandals . . . . . . . .
Tennis shoes . . . . . . . . . .
Walking shoes . . . . . . . . .
Weight Lifting/Training shoes
19
21
23
25
27
02
04
06
08
10
12
14
16
18
20
22
24
26
28
1
2
3
4
BRANDS PURCHASED LAST 12 MONTHS:
Adidas . . . . . . . . . . . . . . . . . .
Airwalk . . . . . . . . . . . . . . . . . .
Asics. . . . . . . . . . . . . . . . . . . .
Avia . . . . . . . . . . . . . . . . . . . .
Brooks . . . . . . . . . . . . . . . . . .
531-0
1
2
3
4
5
Merrell . . . . . . . . . . . . . . . . . .
New Balance . . . . . . . . . . . . .
Nike . . . . . . . . . . . . . . . . . . . .
Puma . . . . . . . . . . . . . . . . . . .
Reebok. . . . . . . . . . . . . . . . . .
532-0
1
2
3
4
5
Converse . . . . . . . . . . . . . . . .
Easy Spirit . . . . . . . . . . . . . . .
Ecko . . . . . . . . . . . . . . . . . . .
Fila . . . . . . . . . . . . . . . . . . . . .
Jordan . . . . . . . . . . . . . . . . . .
6
7
8
9
0
Rockport. . . . . . . . . . . . . . . . .
Saucony . . . . . . . . . . . . . . . . .
Skechers . . . . . . . . . . . . . . . .
Timberland . . . . . . . . . . . . . . .
Under Armour . . . . . . . . . . . .
6
7
8
9
0
Keds . . . . . . . . . . . . . . . . . . . . X
K-Swiss . . . . . . . . . . . . . . . . . Y
Pairs
purchased
in last 12
months
SHOES
529
Canvas . . . . . . . . . . . . . .
Casual/Leisure . . . . . . . .
Dress Boots . . . . . . . . . . .
Dress Shoes . . . . . . . . . .
Sandals . . . . . . . . . . . . . .
01
03
05
07
09
Slippers . . . . . . . . . . . . . .
Western Boots . . . . . . . . .
Work Boots . . . . . . . . . . .
Other Work Shoes . . . . . .
Other . . . . . . . . . . . . . . . .
11
13
15
17
19
AMOUNT SPENT
IN TOTAL IN THE
LAST 12 MONTHS:
Under $50$100$50
$99
$249
$250 +
02
04
06
08
10
12
14
16
18
20
1
2
3
4
62B-0
62A-0
Aerosoles . . . . . . . . . . . . .
ALDO . . . . . . . . . . . . . . . .
Allen-Edmonds. . . . . . . . .
Anne Klein . . . . . . . . . . . .
Børn . . . . . . . . . . . . . . . . .
1
2
3
4
5
Johnston & Murphy. . . . . . . . . 1
Keen . . . . . . . . . . . . . . . . . . . . 2
Kenneth Cole . . . . . . . . . . . . . 3
Naturalizer . . . . . . . . . . . . . . . 4
Nina . . . . . . . . . . . . . . . . . . . . 5
Clarks . . . . . . . . . . . . . . . .
Coach . . . . . . . . . . . . . . . .
Cole Haan . . . . . . . . . . . .
Crocs . . . . . . . . . . . . . . . .
Ecco . . . . . . . . . . . . . . . . .
6
7
8
9
0
Nine West . . . . . . . . . . . . . . . . 6
Rockport . . . . . . . . . . . . . . . . . 7
Skechers. . . . . . . . . . . . . . . . . 8
Sperry. . . . . . . . . . . . . . . . . . . 9
Stacy Adams. . . . . . . . . . . . . . 0
Florsheim . . . . . . . . . . . . . X
Havaianas . . . . . . . . . . . . Y
Steve Madden. . . . . . . . . . . . . X
UGG . . . . . . . . . . . . . . . . . . . . Y
62T-0
Other. . . . . . . . . . . . . . . . . . . . 1
Vans . . . . . . . . . . . . . . . . . . . . X
Wolverine . . . . . . . . . . . . . . . . Y
60A-0
Other . . . . . . . . . . . . . . . . . . . 1
FASHION &
STYLE ATTITUDES
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.
32.
Please indicate how much you AGREE or DISAGREE with each of
the following statements by checking the box that comes closest
to how you feel.
DISAGREE
62C
Being able to customize an item makes me more willing to purchase it. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Comfort is one of the most important factors when selecting fashion products to purchase. . . . . . . . . . . . . . .
I prefer fashion that is classic and timeless as opposed to trendy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I rely on magazines to keep me up to date on fashion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I am loyal to only a few fashion brands and stick with them. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I only buy shoes and clothing when I have to replace something. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I often spend more money than I expected to on my fashion purchases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
When buying fashion products, the overall look is more important than the brand. . . . . . . . . . . . . . . . . . . . . .
When I find a haircut that suits me, I stick with it. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I follow a strict skin-care routine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I am content with my appearance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I must admit I wear designer brands partially to impress other people. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
When a celebrity designs a product, I am more likely to buy it. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I consider my fashion style to be trendy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I often use natural or organic beauty products. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I buy new clothes at the beginning of each season. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I only spend what I budget on fashion items. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I often try different ways to style my hair. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I love to mix and match high and low end designers when putting together an outfit. . . . . . . . . . . . . . . . . . . .
I’ll buy trendy clothes even if they’re not the highest quality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I am more likely to buy a brand that I know supports a charity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
You can tell a lot about a person by the clothes they wear. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Clothes made by fashion designers are more appealing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I’m willing to use the Internet to shop for fashion products. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I generally wear sunscreen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I prefer to shop for fashion products on my own, rather than with friends. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I dress more to please myself than to please others. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I would consider having a cosmetic surgery or procedure to improve my appearance. . . . . . . . . . . . . . . . . . .
When I smell a perfume or cologne sample that I like in a magazine, I will purchase it.. . . . . . . . . . . . . . . . . .
Maintaining a youthful appearance is important to me.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I judge others by how “put together” they look. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
It is important to me to be well-groomed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
AGREE
Completely
Somewhat
1
2
Somewhat Completely
3
4
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
APPAREL
Page 42
AMOUNT SPENT
IN TOTAL IN THE
LAST 12 MONTHS:
Under
$100$100
$249
$250 +
How many
did you buy
in the last
12 months
MEN’S CLOTHING
527
All-Weather Coats . . . . . . . . . .
Leather Coat, Jacket . . . . . . . .
Fur Coat, Jacket . . . . . . . . . . . .
Overcoat. . . . . . . . . . . . . . . . . .
Parka . . . . . . . . . . . . . . . . . . . .
01
03
05
07
09
02
04
06
08
10
Ski Jacket . . . . . . . . . . . . . . . . .
Formalwear (tuxedo) . . . . . . . .
Business Suit . . . . . . . . . . . . . .
Casual/Non-Business Suit . . . .
Sports Jacket . . . . . . . . . . . . . .
11
13
15
17
19
12
14
16
18
20
1
2
528
3
$50$99
$100$249
$250 +
01
03
05
07
09
02
04
06
08
10
Sweater . . . . . . . . . . . . . . . . . .
Dress Shirt . . . . . . . . . . . . . . . .
Sports Shirt . . . . . . . . . . . . . . .
Nightwear . . . . . . . . . . . . . . . . .
Underwear (Number of pairs). .
11
13
15
17
19
12
14
16
18
20
Cloth Handkerchiefs . . . . . . . . .
Gloves . . . . . . . . . . . . . . . . . . .
Hat . . . . . . . . . . . . . . . . . . . . . .
Necktie . . . . . . . . . . . . . . . . . . .
Belt . . . . . . . . . . . . . . . . . . . . . .
21
23
25
27
29
22
24
26
28
30
Wallet . . . . . . . . . . . . . . . . . . . .
T-shirt (not undershirt) . . . . . . .
Socks . . . . . . . . . . . . . . . . . . . .
Sweatpants. . . . . . . . . . . . . . . .
Sweatshirt . . . . . . . . . . . . . . . .
Swimsuit . . . . . . . . . . . . . . . . . .
31
33
35
37
39
41
32
34
36
38
40
42
1
2
3
6
7
8
9
0
X
535-0
1
2
3
4
5
Eddie Bauer . . . . . . . . . . . . . .
Express . . . . . . . . . . . . . . . . .
Fruit of the Loom . . . . . . . . . .
The Gap . . . . . . . . . . . . . . . . .
H&M . . . . . . . . . . . . . . . . . . . .
Haggar . . . . . . . . . . . . . . . . . .
Hanes. . . . . . . . . . . . . . . . . . .
IZOD. . . . . . . . . . . . . . . . . . . .
Jockey . . . . . . . . . . . . . . . . . .
Jones New York . . . . . . . . . . .
Kenneth Cole . . . . . . . . . . . . .
6
7
8
9
0
X
62E-0
1
2
3
4
5
Nike . . . . . . . . . . . . . . . . . . . . 6
The North Face . . . . . . . . . . . 7
64C-0
1
2
3
4
5
Old Navy. . . . . . . . . . . . . . . . .
Polo . . . . . . . . . . . . . . . . . . . .
Ralph Lauren . . . . . . . . . . . . .
Reebok . . . . . . . . . . . . . . . . . .
Russell Athletic. . . . . . . . . . . .
Speedo. . . . . . . . . . . . . . . . . .
Tommy Hilfiger . . . . . . . . . . . .
Under Armour. . . . . . . . . . . . .
Van Heusen . . . . . . . . . . . . . .
Wrangler. . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . .
6
7
8
9
0
X
Total Amount You Spent
in the Last 12 Months:
536
Athletic/Workout wear . . . . . . . . . . . . . .
Bicycle clothing. . . . . . . . . . . . . . . . . . . .
Golf clothing . . . . . . . . . . . . . . . . . . . . . .
Hiking/Backpacking clothing. . . . . . . . . .
Hunting clothing . . . . . . . . . . . . . . . . . . .
Marine/Boating attire . . . . . . . . . . . . . . .
Running clothing . . . . . . . . . . . . . . . . . .
Ski clothing. . . . . . . . . . . . . . . . . . . . . . .
Team Sports clothing . . . . . . . . . . . . . . .
Tennis clothing . . . . . . . . . . . . . . . . . . . .
Ski Jacket . . . . . . . . . . . . . . . . .
Suit (with skirt) . . . . . . . . . . . . .
Evening Dress . . . . . . . . . . . . .
Pants Suit . . . . . . . . . . . . . . . . .
Blazer . . . . . . . . . . . . . . . . . . . .
01
03
05
07
09
11
13
15
17
19
AMOUNT SPENT
IN TOTAL IN THE
LAST 12 MONTHS:
Under
$100$100
$249
$250 +
02
04
06
08
10
12
14
16
18
20
534
Dress . . . . . . . . . . . . . . . . . . . .
Maternity Clothes . . . . . . . . . .
Skirt . . . . . . . . . . . . . . . . . . . . .
Casual Slacks . . . . . . . . . . . . .
Dress Slacks . . . . . . . . . . . . . .
Designer Jeans . . . . . . . . . . . .
Jeans . . . . . . . . . . . . . . . . . . . .
Sweater . . . . . . . . . . . . . . . . . .
Blouse/Shirt . . . . . . . . . . . . . . .
Nightwear . . . . . . . . . . . . . . . .
01
03
05
07
09
11
13
15
17
19
Purse (handbag) . . . . . . . . . . .
Gloves . . . . . . . . . . . . . . . . . . .
Hat . . . . . . . . . . . . . . . . . . . . . .
Belt . . . . . . . . . . . . . . . . . . . . .
T-shirt . . . . . . . . . . . . . . . . . . .
21
Socks. . . . . . . . . . . . . . . . . . . .
Sweatpants . . . . . . . . . . . . . . .
Sweatshirt . . . . . . . . . . . . . . . .
Swimsuit . . . . . . . . . . . . . . . . .
31
23
25
27
29
33
35
37
2
3
Under
$50
$50$99
$100$249
$250 +
02
04
06
08
10
12
14
16
18
20
22
24
26
28
30
32
34
36
38
1
2
3
4
Lacoste. . . . . . . . . . . . . . . . . .
Lands’ End . . . . . . . . . . . . . . .
Lee . . . . . . . . . . . . . . . . . . . . .
Levi’s . . . . . . . . . . . . . . . . . . .
Nautica . . . . . . . . . . . . . . . . . .
SPORTS CLOTHING
533
Fur Coat, Jacket, Stole . . . . . . .
Leather Coat, Jacket . . . . . . . .
Cloth Coat . . . . . . . . . . . . . . . .
Raincoat . . . . . . . . . . . . . . . . . .
Parka . . . . . . . . . . . . . . . . . . . .
4
62D-0
1
2
3
4
5
How many
did you buy
in the last
12 months
1
Under
$50
Lightweight Jacket . . . . . . . . . .
Casual Slacks. . . . . . . . . . . . . .
Dress Slacks . . . . . . . . . . . . . .
Designer Jeans . . . . . . . . . . . .
Jeans . . . . . . . . . . . . . . . . . . . .
Adidas . . . . . . . . . . . . . . . . . .
Armani . . . . . . . . . . . . . . . . . .
Banana Republic . . . . . . . . . .
Brooks Brothers . . . . . . . . . . .
Calvin Klein . . . . . . . . . . . . . .
Carhartt . . . . . . . . . . . . . . . . .
Champion. . . . . . . . . . . . . . . .
Claiborne . . . . . . . . . . . . . . . .
Dickies . . . . . . . . . . . . . . . . . .
DKNY . . . . . . . . . . . . . . . . . . .
Dockers . . . . . . . . . . . . . . . . .
WOMEN’S CLOTHING
Under
$100
$100$149
$150$299
$300 +
01
02
03
04
05
06
07
08
09
10
1
2
3
4
62F-0
1
2
3
4
5
6
7
8
9
544-0
. 1
. 2
. 3
. 4
. 5
. 6
. 7
62G-0
. 1
. 2
. 3
. 4
. 5
. 6
. 7
. 8
64D-0
Adidas . . . . . . . . . . . . . . . . . .
Alfred Dunner . . . . . . . . . . . . .
Ann Taylor. . . . . . . . . . . . . . . .
Anne Klein . . . . . . . . . . . . . . .
Armani . . . . . . . . . . . . . . . . . .
Banana Republic . . . . . . . . . .
Calvin Klein . . . . . . . . . . . . . .
Champion. . . . . . . . . . . . . . . .
Danskin . . . . . . . . . . . . . . . . .
Levi’s . . . . . . . . . . . . . . . . . . .
Liz Claiborne . . . . . . . . . . . . .
LOFT . . . . . . . . . . . . . . . . . . .
Lucky Brand . . . . . . . . . . . . . .
New York & Company. . . . . . .
Nike . . . . . . . . . . . . . . . . . . . .
The North Face . . . . . . . . . . .
Not Your Daughter’s Jeans . . .
Old Navy. . . . . . . . . . . . . . . . .
DKNY . . . . . . . . . . . . . . . . . .
Dockers . . . . . . . . . . . . . . . .
Eddie Bauer . . . . . . . . . . . . .
Express . . . . . . . . . . . . . . . .
The Gap . . . . . . . . . . . . . . . .
Guess. . . . . . . . . . . . . . . . . .
H&M . . . . . . . . . . . . . . . . . . .
Polo . . . . . . . . . . . . . . . . . . . .
Ralph Lauren . . . . . . . . . . . . .
Reebok . . . . . . . . . . . . . . . . . .
Riders . . . . . . . . . . . . . . . . . . .
Sag Harbor . . . . . . . . . . . . . . .
Hanes . . . . . . . . . . . . . . . . .
Inc. . . . . . . . . . . . . . . . . . . . .
IZOD. . . . . . . . . . . . . . . . . . .
Jones New York . . . . . . . . . .
Juicy Couture . . . . . . . . . . . .
Kenneth Cole . . . . . . . . . . . .
Lacoste. . . . . . . . . . . . . . . . .
Lee . . . . . . . . . . . . . . . . . . . .
CLOTHING
EXPENDITURES
537-0
1
2
3
4
5
6
7
8
9
62M-0
1
2
3
4
5
Speedo. . . . . . . . . . . . . . . . . .
Talbots . . . . . . . . . . . . . . . . . .
Tommy Hilfiger . . . . . . . . . . . .
True Religion . . . . . . . . . . . . .
Under Armour. . . . . . . . . . . . .
6
7
8
9
0
Wrangler. . . . . . . . . . . . . . . . . X
Other . . . . . . . . . . . . . . . . . . . Y
In the past 12 months,
how much did you spend
on the purchase
of clothing:
Under $100. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
$1,100 - $299 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
$1,300 - $499 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
$1,500 - $999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
$1,000 - $1,999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
$2,000 - $2,999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
$3,000 + . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
ACCESSORIES, LINGERIE, WRITING INSTRUMENTS, TOOLS
Page 43
FINE
JEWELRY
538
You Personally:
Number
Bought/
Bought
last 12
last 12
months
months
KINDS:
Bracelet . . . . . . . . . . . . . . . .
Brooch/Pin . . . . . . . . . . . . . .
Earrings . . . . . . . . . . . . . . . .
Necklace. . . . . . . . . . . . . . . .
Engagement Ring. . . . . . . . .
Other Ring . . . . . . . . . . . . . .
TYPES:
Diamond. . . . . . . . . . . . . . . .
Gold . . . . . . . . . . . . . . . . . . .
Platinum . . . . . . . . . . . . . . . .
Sterling . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . .
02
03
04
05
06
07
08
09
10
11
539-0
1
2
3
4
5
6
Where Purchased:
64B-0
Independent Jeweler . . . . . . 1
Department Store. . . . . . . . . 2
Jared . . . . . . . . . . . . . . . . . . 3
Kay Jewelers . . . . . . . . . . . . 4
Swarovski . . . . . . . . . . . . . . . 5
Zales . . . . . . . . . . . . . . . . . . 6
TOTAL:
................. TYPES:
Bras . . . . . . . . . . . . . . . . . . .
Sports Bras . . . . . . . . . . . . .
Panties . . . . . . . . . . . . . . . . .
Pantyhose . . . . . . . . . . . . . .
Tights . . . . . . . . . . . . . . . . . .
00
01
02
03
04
05
Leggings. . . . . . . . . . . . . . . . Shapewear . . . . . . . . . . . . . . BRANDS:
Bali . . . . . . . . . . . . . . . . . . . .
Barely There . . . . . . . . . . . . .
Fruit of the Loom . . . . . . . . .
Hanes. . . . . . . . . . . . . . . . . .
Jockey . . . . . . . . . . . . . . . . .
Just My Size . . . . . . . . . . . . .
Lane Bryant . . . . . . . . . . . . .
L’eggs . . . . . . . . . . . . . . . . . .
Maidenform . . . . . . . . . . . . .
No Nonsense . . . . . . . . . . . .
Playtex . . . . . . . . . . . . . . . . .
Spanx . . . . . . . . . . . . . . . . . .
Vanity Fair. . . . . . . . . . . . . . .
Vassarette. . . . . . . . . . . . . . .
Victoria’s Secret . . . . . . . . . .
06
COSTUME JEWELRY
540
You Personally:
Bought/
last 12
months
Own
541
KINDS:
1
Sport. . . . . . . . . . . . . . . . . . . Dress . . . . . . . . . . . . . . . . . . Casual . . . . . . . . . . . . . . . . . 01
02
03
BRANDS:
Anne Klein . . . . . . . . . . . . . .
Breitling . . . . . . . . . . . . . . . .
Bulova . . . . . . . . . . . . . . . . .
Cartier . . . . . . . . . . . . . . . . .
Casio . . . . . . . . . . . . . . . . . .
04
05
06
07
08
Citizen . . . . . . . . . . . . . . . . .
Fossil . . . . . . . . . . . . . . . . . .
Gucci . . . . . . . . . . . . . . . . . .
Guess. . . . . . . . . . . . . . . . . .
Movado. . . . . . . . . . . . . . . . .
09
10
11
12
13
Omega . . . . . . . . . . . . . . . . .
Rolex . . . . . . . . . . . . . . . . . .
Seiko . . . . . . . . . . . . . . . . . .
Swatch . . . . . . . . . . . . . . . . .
Tag Heuer. . . . . . . . . . . . . . .
14
15
16
17
18
Timex . . . . . . . . . . . . . . . . . . Victorinox Swiss Army . . . . . Other . . . . . . . . . . . . . . . . . . 19
20
21
2
Total amount spent on watches
in the last 12 months: 542-0
$1-$49 1 $100-$299 3 $500-$999 5
$50-$99 2 $300-$499 4 $1,000+
6
If purchased in last 12 months, purchased for:
Yourself . . . . . . . . . . . . . . . . . 7
Gift for a man . . . . . . . . . . . . 8
Gift for a woman . . . . . . . . . . 9
You Personally:
Number
Stitched
of times/
in last
last 6
months
6 months
TOOLS
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
999
You Personally:
Number
Bought/
Bought
last 12
last 12
months
months
KINDS:
Bracelet . . . . . . . . . . . . . . . .
Pin . . . . . . . . . . . . . . . . . . . .
Earrings . . . . . . . . . . . . . . . .
Necklace. . . . . . . . . . . . . . . .
Ring . . . . . . . . . . . . . . . . . . .
01
02
03
04
05
Total amount spent on costume jewelry
in the last 12 months: 277-0
$1-$24 1
$50-$99 3 $200+ 5
$25-$49 2
$100-$199 4
WRITING
INSTRUMENTS
You Personally:
Bought in
Bought
last 12
as
gift
months
546
TYPES:
Matched Set . . . . . . . . . . . . .
Ball Point . . . . . . . . . . . . . . .
Mechanical Lead Pencil . . . .
Rollerball . . . . . . . . . . . . . . .
Marker . . . . . . . . . . . . . . . . .
01
02
03
04
05
BRANDS:
Bic . . . . . . . . . . . . . . . . . . . .
Classic . . . . . . . . . . . . . . . . .
Crayola . . . . . . . . . . . . . . . . .
Cross . . . . . . . . . . . . . . . . . .
Expo . . . . . . . . . . . . . . . . . . .
06
07
08
09
10
Montblanc. . . . . . . . . . . . . . .
Paper Mate. . . . . . . . . . . . . .
Parker. . . . . . . . . . . . . . . . . .
Pentel . . . . . . . . . . . . . . . . . .
Pilot . . . . . . . . . . . . . . . . . . .
11
12
13
14
15
Scripto . . . . . . . . . . . . . . . . .
Sharpie. . . . . . . . . . . . . . . . .
Uni-ball . . . . . . . . . . . . . . . . .
Waterman . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . .
16
17
18
19
20
1
TYPES:
Sewing – General Mending .
Sewing – Garments from
Patterns . . . . . . . . . . . . . .
Knitting . . . . . . . . . . . . . . . . .
Crocheting . . . . . . . . . . . . . .
Cross-stitch . . . . . . . . . . . . .
Needlepoint . . . . . . . . . . . . .
Quilting . . . . . . . . . . . . . . . . .
07
OTHER (Write In)
Purchased for:
Yourself . . . . . . . . . . . . . . . . . 0
Someone else (gift) . . . . . . . X
NEEDLECRAFT AND
SEWING
543
Warner’s . . . . . . . . . . . . . . . . Other Retail Chain . . . . . . . . 7
Warehouse/Club Store . . . . . 8
Other . . . . . . . . . . . . . . . . . . 9
WATCHES
You Personally:
Number
Bought
Bought
last
last 12
months
12 months
545
01
Total amount spent on fine jewelry
in the last 12 months:
Under $100. . . . . . . . . . . . . .
$100-$399 . . . . . . . . . . . . . .
$400-$749 . . . . . . . . . . . . . .
$750-$999 . . . . . . . . . . . . . .
$1,000-$1,499 . . . . . . . . . . .
$1,500+ . . . . . . . . . . . . . . . .
WOMEN’S LINGERIE/
UNDERGARMENTS
2
01
02
03
04
05
06
07
Your Household:
Acquired/
last 12
months
Owns
225
1
Air compressor (not 12 volt
inflator) . . . . . . . . . . . . . . .
Automotive tools . . . . . . . . . .
Car vacuum . . . . . . . . . . . . .
Chain saw (gas) . . . . . . . . . .
Chain saw (electric) . . . . . . .
Chipper/Shredder . . . . . . . . .
Circular saw (portable) . . . . .
Decorative paint tools/kits . .
Drive bits . . . . . . . . . . . . . . .
Electric car polisher . . . . . . .
Electric drill – cordless . . . . .
Electric drill – corded . . . . . .
Electric router . . . . . . . . . . . .
Electric sander . . . . . . . . . . .
Electric screwdriver
(cordless) . . . . . . . . . . . . .
Glue gun. . . . . . . . . . . . . . . .
Hand tools . . . . . . . . . . . . . .
Jig/sabre saw (portable) . . . .
Lawn mower – riding . . . . . .
Lawn mower (non-power). . .
Lawn mower, walk behind
(electric) . . . . . . . . . . . . . .
Lawn mower, walk behind
(gas) . . . . . . . . . . . . . . . . .
Lawn or garden tractor . . . . .
Lawn sprinkler . . . . . . . . . . .
Leaf shredder . . . . . . . . . . . .
Outdoor blower (gas) . . . . . .
Outdoor blower (electric) . . .
Paint sprayer . . . . . . . . . . . .
Pliers . . . . . . . . . . . . . . . . . .
Pneumatic tools . . . . . . . . . .
Power ratchet; cordless . . . .
Saw blades. . . . . . . . . . . . . .
Shears (non-electric) . . . . . .
Shovel . . . . . . . . . . . . . . . . .
Snowblower . . . . . . . . . . . . .
Staple gun . . . . . . . . . . . . . .
Stationary band saw. . . . . . .
Stationary drill press. . . . . . .
Stationary table saw . . . . . . .
Stationary radial arm saw. . .
Tiller (garden) . . . . . . . . . . . .
Trimmer/edger (electric) . . . .
Trimmer/edger (gas) . . . . . . .
Wallpaper stripper . . . . . . . .
Welder . . . . . . . . . . . . . . . . .
Wet-dry shop vacuum. . . . . .
Workbench (portable). . . . . .
Other . . . . . . . . . . . . . . . . . .
2
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
Who decided to make these purchases?
227-0
someone else) . . . . . . . . . 1
Someone else . . . . . . . . . . . 2
FURNITURE STORES, HOUSEHOLD FURNISHINGS, PAINT
HOUSEHOLD
FURNISHINGS
Your Household:
AMOUNT SPENT IN LAST 12 MONTHS
Bought
last 12
months
$1000
or
more
Owns
550
$1$249
$250$699
$700$999
1
2
3
4
5
Wall unit/wall system . . . . . . . . . . . . . . .
Sofa/sectional. . . . . . . . . . . . . . . . . . . . .
Recliner . . . . . . . . . . . . . . . . . . . . . . . . .
Sofa-bed convertible . . . . . . . . . . . . . . .
Other living room furniture . . . . . . . . . . .
01
02
03
04
05
Bed frame/headboard. . . . . . . . . . . . . . .
Box spring . . . . . . . . . . . . . . . . . . . . . . .
Mattress . . . . . . . . . . . . . . . . . . . . . . . . .
Cedar chests . . . . . . . . . . . . . . . . . . . . .
Other bedroom furniture. . . . . . . . . . . . .
06
07
08
09
10
6
Kitchen furniture. . . . . . . . . . . . . . . . . . .
Dining room furniture . . . . . . . . . . . . . . .
Family room furniture . . . . . . . . . . . . . . .
Home office furniture . . . . . . . . . . . . . . .
Piano . . . . . . . . . . . . . . . . . . . . . . . . . . .
11
12
13
14
15
Picture frames—custom made . . . . . . . .
Window coverings—custom made . . . . .
Wall-to-wall carpet . . . . . . . . . . . . . . . . .
Horizontal blinds—custom made . . . . . .
Vertical blinds—custom made . . . . . . . .
16
17
18
19
20
Owns
Bought
last 12
months
$1$99
$100$299
$300$499
551
$500
or
more
1
2
3
4
5
Awning . . . . . . . . . . . . . . . . . . . . . . . . . .
Draperies . . . . . . . . . . . . . . . . . . . . . . . .
Curtains . . . . . . . . . . . . . . . . . . . . . . . . .
Horizontal blinds—ready made . . . . . . .
Vertical blinds—ready made. . . . . . . . . .
01
02
03
04
05
Pleated shades. . . . . . . . . . . . . . . . . . . .
Lawn/porch furniture . . . . . . . . . . . . . . .
Patio/deck cover . . . . . . . . . . . . . . . . . . .
Air mattress (Inflatable). . . . . . . . . . . . . .
Upholstery fabric . . . . . . . . . . . . . . . . . .
06
07
08
09
10
Area rug . . . . . . . . . . . . . . . . . . . . . . . . .
Room size rug . . . . . . . . . . . . . . . . . . . .
Indoor/outdoor carpet. . . . . . . . . . . . . . .
Table/floor lamps . . . . . . . . . . . . . . . . . .
11
12
13
14
6
552-0
1 Yourself (alone or with someone else)
2 Someone else
Did your household rent any of the above furnishings in the last 12 months?
Yes 3
APPLIANCES FOR
CLIMATE CONTROL
Your Household:
Owns
553
Bought
last 12
months
AMOUNT SPENT IN LAST 12 MONTHS
$1$99
$100$399
$400$999
$1000
or
more
1
2
3
4
5
Air cleaner—electric . . . . . . . . . . . . . . . .
Central air conditioner . . . . . . . . . . . . . .
Air conditioner—separate room . . . . . . .
Attic/whole house fan . . . . . . . . . . . . . . .
Ceiling fan (not bathroom vent) . . . . . . .
01
02
03
04
05
Coal/wood stove . . . . . . . . . . . . . . . . . . .
Central heating—gas . . . . . . . . . . . . . . .
Central heating—oil . . . . . . . . . . . . . . . .
Electric heating (central) . . . . . . . . . . . .
Space heater (electric) . . . . . . . . . . . . . .
06
07
08
09
10
Automatic setback thermostat . . . . . . . .
Dehumidifier . . . . . . . . . . . . . . . . . . . . . .
Humidifier . . . . . . . . . . . . . . . . . . . . . . . .
Fireplace. . . . . . . . . . . . . . . . . . . . . . . . .
Heat pump . . . . . . . . . . . . . . . . . . . . . . .
Kerosene heater . . . . . . . . . . . . . . . . . . .
11
12
13
14
15
16
554-0
2 Someone else
PAINT/STAIN
6
Page 44
You Personally:
Bought/
Gallons/
last 12
last 12
months
months
555
TOTAL:
................. TYPES:
Interior paint . . . . . . . . . . . . .
Exterior paint . . . . . . . . . . . .
Interior stain . . . . . . . . . . . . .
Exterior stain . . . . . . . . . . . .
00
01
02
03
04
KINDS:
Brush/roller. . . . . . . . . . . . . . Spray . . . . . . . . . . . . . . . . . . 05
FORMS:
Latex/water-based . . . . . . . . Oil-based . . . . . . . . . . . . . . . 07
BRANDS:
Ace . . . . . . . . . . . . . . . . . . . .
Behr . . . . . . . . . . . . . . . . . . .
Benjamin Moore . . . . . . . . . .
Cabot . . . . . . . . . . . . . . . . . .
Dutch Boy. . . . . . . . . . . . . . .
Glidden. . . . . . . . . . . . . . . . .
KILZ . . . . . . . . . . . . . . . . . . .
Krylon . . . . . . . . . . . . . . . . . .
Minwax . . . . . . . . . . . . . . . . .
Olympic . . . . . . . . . . . . . . . .
Ralph Lauren . . . . . . . . . . . .
Rust-Oleum . . . . . . . . . . . . .
Sherwin Williams . . . . . . . . .
Thompson’s WaterSeal . . . .
True Value. . . . . . . . . . . . . . .
Valspar . . . . . . . . . . . . . . . . .
Walmart (Color Place) . . . . .
OTHER (Write In)
06
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
999
WHERE PURCHASED:
556-0
Hardware Store . . . . . . . . . . 1
Home Center Store . . . . . . . 2
Department Store. . . . . . . . . 3
Discount Store . . . . . . . . . . . 4
Lumber/Building Supply . . . . 5
Paint Store . . . . . . . . . . . . . . 6
Other . . . . . . . . . . . . . . . . . . 7
AMOUNT SPENT:
Less than $50. . . . . . . . . . . .
$50-$100 . . . . . . . . . . . . . . .
$101-$300 . . . . . . . . . . . . . .
Over $300 . . . . . . . . . . . . . .
FURNITURE
STORES
8
9
0
X
You Personally:
Shopped
Times
last 12
in last 12
months
months
67J
Aaron’s . . . . . . . . . . . . . . . .
Art Van Furniture . . . . . . . .
Ashley HomeStore . . . . . . .
Cost Plus World Market . . .
Ethan Allen . . . . . . . . . . . . .
Havertys . . . . . . . . . . . . . . .
IKEA . . . . . . . . . . . . . . . . . .
Jennifer Leather/
Convertibles. . . . . . . . . . .
Jordan’s Furniture . . . . . . . .
LA-Z-Boy Furniture
Galleries . . . . . . . . . . . . .
Raymour & Flanigan. . . . . .
RAC Rent-A-Center . . . . . .
Restoration Hardware. . . . .
Rooms To Go . . . . . . . . . . .
Thomasville . . . . . . . . . . . .
Value City Furniture . . . . . . Walter E. Smithe. . . . . . . . . 01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
KITCHEN & HOUSEHOLD APPLIANCES & DURABLES
Page 45
Your Household:
Bought
last 12
Owns
months
KITCHEN COOKING
AND SERVING
PRODUCTS
560
1
Aluminum cookware . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other metal cookware . . . . . . . . . . . . . . . . . . . . . . . . .
Barbecue equipment . . . . . . . . . . . . . . . . . . . . . . . . . .
Canning jars & lids . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Ceramic coated cookware . . . . . . . . . . . . . . . . . . . . . .
Cutlery (kitchen knives) . . . . . . . . . . . . . . . . . . . . . . . .
Insulated coffee carafe/server. . . . . . . . . . . . . . . . . . . .
Wok (non-electric) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Glass storage containers . . . . . . . . . . . . . . . . . . . . . . .
Plastic storage containers . . . . . . . . . . . . . . . . . . . . . .
Glass ovenware/bakeware . . . . . . . . . . . . . . . . . . . . . .
Non-stick metal bakeware/ovenware . . . . . . . . . . . . . .
Glass rangetop cookware. . . . . . . . . . . . . . . . . . . . . . .
Microwave cookware:
glass/ceramic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
plastic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
paper/disposable. . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
567
Your Household:
Bought
last 12
Owns
months
563
1
Bread making machine. . . . . . . . . . . . . . . . . . . . . . . . .
Coffee maker – automatic drip . . . . . . . . . . . . . . . . . . .
Coffee maker – electric perk. . . . . . . . . . . . . . . . . . . . .
Coffee maker – single cup/pod brewing system . . . . . .
Coffee maker – other electric . . . . . . . . . . . . . . . . . . . .
Coffee maker – French press . . . . . . . . . . . . . . . . . . . .
Espresso/Cappuccino Maker . . . . . . . . . . . . . . . . . . . .
Deep fryer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Electric blender. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Electric can opener. . . . . . . . . . . . . . . . . . . . . . . . . . . .
Electric coffee grinder. . . . . . . . . . . . . . . . . . . . . . . . . .
Electric food processor . . . . . . . . . . . . . . . . . . . . . . . . .
Electric fry pan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Electric grill – indoor . . . . . . . . . . . . . . . . . . . . . . . . . . .
Electric juicer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Electric knife . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Electric mixer – hand held . . . . . . . . . . . . . . . . . . . . . .
Electric mixer – stationary . . . . . . . . . . . . . . . . . . . . . .
Electric popcorn maker. . . . . . . . . . . . . . . . . . . . . . . . .
Electric slow cooker . . . . . . . . . . . . . . . . . . . . . . . . . . .
Electric steam cooker . . . . . . . . . . . . . . . . . . . . . . . . . .
Electric wok . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Ice cream machine . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Pasta machine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Pressure cooker . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Toaster . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Toaster oven . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Vacuum sealer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
570
Blood glucose monitor . . . . .
Clock – battery. . . . . . . . . . .
Clock radio – electric . . . . .
Electronic ear thermometer .
Hand-held massagers . . . . .
Hearing aids . . . . . . . . . . . .
Home blood pressure
monitor . . . . . . . . . . . . . . .
Lighted make-up mirror . . . .
Massaging shower head . . .
Oral irrigation device . . . . . .
Scale (bathroom) . . . . . . . .
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
Did your household rent any of the above items in the last 12 months?
568-0 Yes 1
No 2
569-0 1 Yourself (alone or with someone else)
2 Someone else
2
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
2 Someone else
You Personally:
2
562-0
SMALL KITCHEN
APPLIANCES
PERSONAL
APPLIANCES
1
Dishwasher – built-in . . . . . . . . . . . . . . . . . . . . . . . . . .
Dishwasher – portable . . . . . . . . . . . . . . . . . . . . . . . . .
Built-in range oven – electric . . . . . . . . . . . . . . . . . . . .
Built-in range oven – gas . . . . . . . . . . . . . . . . . . . . . . .
Electric stove/range . . . . . . . . . . . . . . . . . . . . . . . . . . .
Gas stove/range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Induction range/oven . . . . . . . . . . . . . . . . . . . . . . . . . .
Continuous cleaning oven . . . . . . . . . . . . . . . . . . . . . .
Convection oven . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Cook top . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Microwave oven . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Combination range/microwave . . . . . . . . . . . . . . . . . . .
Rangehood. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Refrigerator. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Separate freezer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Charcoal grill. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Electric grill – outdoor. . . . . . . . . . . . . . . . . . . . . . . . . .
Gas grill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Smoker . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Trash compactor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Garbage disposal . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
561-0
2 Someone else
Have you purchased any of the above as a gift?
Yes 1
No 2
Your Household:
Bought
last 12
Owns
months
LARGE KITCHEN
& COOKING
APPLIANCES
565
Own
$1$24
$25$49
1
2
3
4
01
02
03
04
05
06
07
08
09
10
11
1
Air purifier . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Broom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Burglar alarm/Home Security System . . . . . . . . . . . . .
Carpet steam cleaner . . . . . . . . . . . . . . . . . . . . . . . . . .
Clothes dryer – electric. . . . . . . . . . . . . . . . . . . . . . . . .
Clothes dryer – gas . . . . . . . . . . . . . . . . . . . . . . . . . . .
Garage door opener . . . . . . . . . . . . . . . . . . . . . . . . . . .
Generator (portable) . . . . . . . . . . . . . . . . . . . . . . . . . . .
Home fire extinguisher . . . . . . . . . . . . . . . . . . . . . . . . .
Hot tub/whirlpool spa . . . . . . . . . . . . . . . . . . . . . . . . . .
Hot water heater . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Iron . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Locks or lock sets . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mop . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Rechargeable flashlight . . . . . . . . . . . . . . . . . . . . . . . .
Other battery flashlight . . . . . . . . . . . . . . . . . . . . . . . . .
Sewing machine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Smoke/fire detector. . . . . . . . . . . . . . . . . . . . . . . . . . . .
Vacuum cleaner – cannister . . . . . . . . . . . . . . . . . . . . .
Vacuum cleaner – hand held . . . . . . . . . . . . . . . . . . . .
Vacuum cleaner – upright. . . . . . . . . . . . . . . . . . . . . . .
Washing machine – high efficiency . . . . . . . . . . . . . . .
Washing machine – standard . . . . . . . . . . . . . . . . . . . .
Washer/dryer – stacked . . . . . . . . . . . . . . . . . . . . . . . .
Water softener . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
2 Someone else
Amount spent last
12 months
Bought
last 12
months
Your Household:
Bought
last 12
Owns
months
HOUSEHOLD
APPLIANCES &
DURABLES
TABLE SETTINGS
571
$50 +
Cloth tablecloth/napkins . . . . . . . . . . . . . . . . .
Fine china dinnerware . . . . . . . . . . . . . . . . . .
Glassware. . . . . . . . . . . . . . . . . . . . . . . . . . . .
Fine china serving pieces. . . . . . . . . . . . . . . .
Fine crystal barware . . . . . . . . . . . . . . . . . . . .
Lead crystal hollowware . . . . . . . . . . . . . . . . .
Lead crystal stemware . . . . . . . . . . . . . . . . . .
Silverplated flatware . . . . . . . . . . . . . . . . . . . .
Stainless flatware . . . . . . . . . . . . . . . . . . . . . .
Sterling silver flatware. . . . . . . . . . . . . . . . . . .
Stoneware. . . . . . . . . . . . . . . . . . . . . . . . . . . .
Placemats. . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other dinnerware . . . . . . . . . . . . . . . . . . . . . .
5
You Personally:
Bought
last 12
Bought
Own
months
as gift
1
2
Amount personally spent on table settings, last 12 months:
$
572-0
(Write in Amount)
3
01
02
03
04
05
06
07
08
09
10
11
12
13
HOME IMPROVEMENTS & REMODELING,
BEDDING, SHOPPING
HOME REMODELING
573
Your
Household:
Had done
last 12
months
Who did the work:
Yourself or
Other Household
Outside
Member
Contractor
Page 46
Under
$1000
$1000$2999
$3000
or
more
Conversion of garage/attic/
basement into living space . . . .
Remodel bathroom. . . . . . . . . . . .
Remodel kitchen. . . . . . . . . . . . . .
Remodel bedroom . . . . . . . . . . . .
Convert room to home office . . . .
1
2
3
4
5
6
01
02
03
04
05
Convert room to home theater . . .
Remodel other rooms. . . . . . . . . .
Add bathroom. . . . . . . . . . . . . . . .
Add/extend garage . . . . . . . . . . . .
Add other rooms – exterior addition
06
07
08
09
10
Add deck/porch/patio. . . . . . . . . .
Roofing . . . . . . . . . . . . . . . . . . . . .
Siding – vinyl/metal . . . . . . . . . . .
Aluminum windows. . . . . . . . . . . .
Clad-wood/Wood windows. . . . . .
11
12
13
14
15
Vinyl windows. . . . . . . . . . . . . . . .
Ceramic tile floors. . . . . . . . . . . . .
Hardwood floors . . . . . . . . . . . . . .
Laminate flooring . . . . . . . . . . . . .
Vinyl flooring. . . . . . . . . . . . . . . . .
16
17
18
19
20
Carpeting . . . . . . . . . . . . . . . . . . .
Kitchen cabinets. . . . . . . . . . . . . .
Kitchen counter tops. . . . . . . . . . .
Skylights. . . . . . . . . . . . . . . . . . . .
Exterior doors . . . . . . . . . . . . . . . .
21
22
23
24
25
Interior doors . . . . . . . . . . . . . . . .
Garage doors . . . . . . . . . . . . . . . .
Concrete or masonry work . . . . . .
Swimming pool – in ground . . . . .
Ceramic wall tile . . . . . . . . . . . . . .
26
27
28
29
30
Did you use any environmentally friendly/“green” products in any of the above remodeling jobs?
63C-0
Yes 1
How many of the above remodeling jobs did you personally do?
(Write in number)
HOME
IMPROVEMENTS
574-0
Your
Household:
Purchased
last 12
months
575
Who did the work:
Yourself or
Other Household
Outside
Member
Contractor
Amount Spent
Under
$100
$100$499
$500
or
more
1
2
3
4
5
6
Bathroom or kitchen faucets. . . . .
Other bathroom or kitchen
plumbing fixtures. . . . . . . . . . . .
Insulation for ceiling, floor, and/or
walls . . . . . . . . . . . . . . . . . . . . .
Exterior light fixtures. . . . . . . . . . .
Interior light fixtures . . . . . . . . . . .
01
02
03
04
05
Clean-air filter . . . . . . . . . . . . . . . .
Down spouts/gutters . . . . . . . . . .
Yard fence. . . . . . . . . . . . . . . . . . .
Wallpaper/covering . . . . . . . . . . .
Exterior painting . . . . . . . . . . . . . .
Interior painting . . . . . . . . . . . . . .
06
07
08
09
10
11
Has your household used a home decorating service in the last 12 months?
576-0
Yes 1
HOUSEKEEPING
SERVICES
577-0
In the past 12 months how often did you have your home cleaned by:
More than once a week . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Once a week . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2-3 times a month . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Once a month. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Less than once a month. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
In the last 12 months, have you used the following:
580-0
Professional carpet cleaning service . . . . . . . . . .
1
Professional furniture cleaning service . . . . . . . . .
2
557-0
Bathmat (in tub) . . . . . . . . . . . . . . . . . .
Shower Curtain . . . . . . . . . . . . . . . . . .
Towels . . . . . . . . . . . . . . . . . . . . . . . . .
Pillowcases. . . . . . . . . . . . . . . . . . . . . .
Sheets . . . . . . . . . . . . . . . . . . . . . . . . .
Electric blankets . . . . . . . . . . . . . . . . . .
Other blankets . . . . . . . . . . . . . . . . . . .
Bedspreads . . . . . . . . . . . . . . . . . . . . .
Pillows . . . . . . . . . . . . . . . . . . . . . . . . .
Pillow shams . . . . . . . . . . . . . . . . . . . .
Comforters/quilts . . . . . . . . . . . . . . . . .
Dust ruffles . . . . . . . . . . . . . . . . . . . . . .
Total amount spent in last 12 months:
1
2
3
4
5
6
7
8
9
0
X
Y
558-0
1
2
3
Less than $50. . . . . . . . . . . .
$50-$149 . . . . . . . . . . . . . . .
$150+ . . . . . . . . . . . . . . . . . .
2 Someone else
559-0
2 Someone else
CONVENIENCE
STORES
You Personally:
Shopped
Times/
last 30
in last 6
months
days
584
STORES:
AM/PM . . . . . . . . . . . . . . . . .
BP Food Mart. . . . . . . . . . . .
Casey’s General Store . . . . .
Circle K . . . . . . . . . . . . . . . .
Citgo . . . . . . . . . . . . . . . . . .
01
02
03
04
05
Cumberland Farms . . . . . . .
Exxon/Mobil On the Run . . .
QuikTrip . . . . . . . . . . . . . . . .
7-Eleven . . . . . . . . . . . . . . . .
Sheetz . . . . . . . . . . . . . . . . .
06
07
08
09
10
Shell. . . . . . . . . . . . . . . . . . .
Speedway . . . . . . . . . . . . . .
Wawa . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . .
11
12
13
14
What time of day do you usually shop at
convenience stores?
585-0
Morning (5 am-10 am) . . . . . . . . . . . . 1
Mid Day (10 am-2 pm) . . . . . . . . . . . . 2
Afternoon (2 pm-7 pm) . . . . . . . . . . . . 3
Evening (7 pm-midnight) . . . . . . . . . . 4
Which of the following items have you bought/
used in a convenience store in the last 30 days?
586-0
1
2
3
4
5
Breakfast sandwich . . . . . . . Lunch sandwich . . . . . . . . . . Hot dogs . . . . . . . . . . . . . . . Pizza . . . . . . . . . . . . . . . . . . Other grill food . . . . . . . . . . . Ice cream . . . . . . . . . . . . . . . Candy . . . . . . . . . . . . . . . . . Snack foods . . . . . . . . . . . . . Dairy products . . . . . . . . . . . Bread . . . . . . . . . . . . . . . . . . 6
7
8
9
0
Other bakery items . . . . . . . Coffee-Brewed . . . . . . . . . . . Did you use any environmentally friendly/“green” products in any of the above home
improvements? 63D-0
Yes 1
How many of the above improvements did you personally do? (Write in number)
Your Household:
Bought
last 12
months
BEDDING AND
BATH GOODS
Amount Spent
Maid or
Housekeeper
Professional
Cleaning Service
578-0
579-0
1
2
3
4
5
1
2
3
4
5
Milk . . . . . . . . . . . . . . . . . . .
Soft drinks – bottle/can . . . .
Soft drinks – fountain . . . . . .
Juice drinks . . . . . . . . . . . . .
Beer . . . . . . . . . . . . . . . . . . .
X
Y
704-0
1
2
3
4
5
Frozen beverage . . . . . . . . . Cigarettes. . . . . . . . . . . . . . . Lottery tickets. . . . . . . . . . . . Non-prescription drug/OTC . ATM/Financial services . . . . 6
7
8
9
0
Gas . . . . . . . . . . . . . . . . . . . Other (non-food) . . . . . . . . . X
Y
How much money did you personally spend
in convenience stores in the last 30 days?
Amount Spent $ _______________
587-0
CAMERAS, FILM, SHOPPING, GIFT & PREPAID CARDS
Page 47
In the last 6 months, where did you purchase the following items?
SHOPPING
Department
Store
502
Discount
Store
Cosmetics. . . . . . . . . . . . . . . . . . . . . . . . . . .
Perfume/Cologne . . . . . . . . . . . . . . . . . . . . .
Toiletries . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Non-prescription drugs/OTC . . . . . . . . . . . . . . . . . . . . . . . . .
Prescription drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Clothing . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Shoes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
EXPENDITURES
Drug
Store
Grocery
Store
Online
01
02
03
04
05
06
07
2
3
4
593
Convenience SuperStore
market
Beer . . . . . . . . . . . . .
Wine . . . . . . . . . . . . .
Liquor . . . . . . . . . . . .
5
Drug
Store
Wholesale
Club
Online
Other
01
02
03
1
2
3
4
5
6
CAMERAS/
CAMCORDERS
590
You Personally:
Bought
last 12
Own months
TYPES:
Action/P.O.V. . . . . . . . . . . . . . . . .
Compact System Camera . . . . .
Digital Camcorder. . . . . . . . . . . .
Digital Point & Shoot . . . . . . . . .
Digital SLR (Single Lens Reflex) .
Instant Developing Camera . . . . .
35mm . . . . . . . . . . . . . . . . . . . . .
Other. . . . . . . . . . . . . . . . . . . . . .
01
02
03
04
05
06
07
08
BRANDS:
Canon. . . . . . . . . . . . . . . . . . . . .
Fujifilm . . . . . . . . . . . . . . . . . . . .
GoPro . . . . . . . . . . . . . . . . . . . . .
Kodak . . . . . . . . . . . . . . . . . . . . .
Nikon . . . . . . . . . . . . . . . . . . . . .
09
10
11
12
13
Olympus . . . . . . . . . . . . . . . . . . .
Panasonic. . . . . . . . . . . . . . . . . .
Pentax . . . . . . . . . . . . . . . . . . . .
Polaroid . . . . . . . . . . . . . . . . . . .
Samsung . . . . . . . . . . . . . . . . . .
14
15
16
17
18
Sony . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . .
19
20
1
GIFT CARDS &
PREPAID CARDS
ofof
2
FEATURES:
Wi-Fi Enabled. . . . . . . . . . . . . . . 21
Touch Screen LCD . . . . . . . . . . . 22
Waterproof . . . . . . . . . . . . . . . . . 23
What level of photographer do you consider
yourself to be?
63T-0
Amateur . . . . . . . . . . . . . . . .
1
Advanced Amateur . . . . . . . .
2
Professional . . . . . . . . . . . . .
3
Amount spent on cameras/camcorders,
last 12 months:
$
Liquor
Store
You Personally:
CAMERA &
DEVELOPING
ACCESSORIES
591
Albums . . . . . . . . . . . . . . . . .
Batteries . . . . . . . . . . . . . . . .
Camera case . . . . . . . . . . . .
Flash unit . . . . . . . . . . . . . . .
Gadget bags. . . . . . . . . . . . .
Lens filter(s) . . . . . . . . . . . . .
Memory cards . . . . . . . . . . .
Photo paper . . . . . . . . . . . . .
Photo printer. . . . . . . . . . . . .
Picture Frames (Digital) . . . .
Picture Frames (Traditional) . .
Selfie Stick . . . . . . . . . . . . . .
Smartphone adaptive lens . .
Smartphone mini tripods . . .
Telephoto/zoom lens . . . . . .
Tripod . . . . . . . . . . . . . . . . . .
Wideangle lens. . . . . . . . . . .
Other accessory lens(es) . . .
Own
Bought
last 12
months
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
1
2
$
$
$
$
$
Laundry/Laundromats . . . . . Quick Service Copy/Printing $
$
FILM & FILM
PROCESSING
TOTAL:
You Personally:
Number
of cards
bought/last
6 months
Bought
last 6
months
61N
00
TYPES:
American Express . . . . . . . .
MasterCard . . . . . . . . . . . . .
VISA . . . . . . . . . . . . . . . . . .
Book Store. . . . . . . . . . . . . .
Coffee Shop/Store . . . . . . . .
01
02
03
04
05
Department Store . . . . . . . .
Discount Store . . . . . . . . . . .
Electronics Store . . . . . . . . .
Mall . . . . . . . . . . . . . . . . . . .
Restaurant . . . . . . . . . . . . . .
06
07
08
09
10
Other . . . . . . . . . . . . . . . . . . 11
Bought for/Gave to:
61R-0
Family—Adult . . . . . . . . . . . . . . . . . . . . . . .
Family—Child under 18 years . . . . . . . . . . .
Friend . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yourself . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
2
3
4
5
Where purchased:
63S-0
Bank . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Department Store. . . . . . . . . . . . . . . . . . . .
Discount Store . . . . . . . . . . . . . . . . . . . . . .
Mall . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Supermarket. . . . . . . . . . . . . . . . . . . . . . . .
1
2
3
4
5
Drugstore/Pharmacy . . . . . . . . . . . . . . . . .
Other Store. . . . . . . . . . . . . . . . . . . . . . . . .
Internet/Online . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
7
8
9
Have you received a gift or prepaid card
(from someone other than yourself) in the
last 6 months? 61T-0 Yes 1
Received from:
63V-0
Family—Adult . . . . . . . . . . . . . . . . . 1
Family—Child under 18 years . . . . . 2
Friend . . . . . . . . . . . . . . . . . . . . . . . 3
Other . . . . . . . . . . . . . . . . . . . . . . . . 4
After receiving, how long do you usually
wait before redeeming gift or prepaid cards?
61W-0
Less than one month . . . . . . . . . . . .
1 month to less than 6 months . . . . .
6 months to less than 12 months . . .
12 months or more . . . . . . . . . . . . . .
Do not usually redeem . . . . . . . . . . .
1
2
3
4
5
When redeeming a gift or prepaid card do
you typically spend:
Less than the total amount on the
card. . . . . . . . . . . . . . . . . . . . . . . . 6
About the same amount on the card . . 7
More than the amount on the card . . 8
03
04
05
06
07
You Personally:
Purchased
Rolls or
last 12
packs last
months
12 months
................. 00
TYPES:
35mm . . . . . . . . . . . . . . . . . . Instant developing film . . . . . Other . . . . . . . . . . . . . . . . . . TOTAL: . . . . . . . . . . . . . . . . . . Amount spent in total, last 6 months:
$
61S-0
01
02
594
7
(Write in Amount)
63U-0
(Write in Amount)
Barber Shop . . . . . . . . . . . . .
Beauty Parlor/Salon . . . . . . .
Dry Cleaning . . . . . . . . . . . .
Flowers by Phone/Internet . .
Flower Shop . . . . . . . . . . . . .
In the last 6 months, where did you purchase the following alcoholic beverages?
589
You Personally:
Used in
Amount
last 6
spent last
months
6 months
01
02
999
Where was film processed? 596-0
Camera store . . . . . . . . . . . . 1
Discount store . . . . . . . . . . . 2
Drug store. . . . . . . . . . . . . . . 3
Internet/Online . . . . . . . . . . . 4
Warehouse/Club Store . . . . . 5
Develop film yourself . . . . . . 6
Other . . . . . . . . . . . . . . . . . . 7
DIGITAL PHOTOS
Digital photo activities you did, last 12 months:
597-0
Edited photos using software . . . . . . . . .
Edited photos online or with app . . . . . .
Edited photos another way . . . . . . . . . . .
Ordered photobook/calendar . . . . . . . . .
Ordered photo cards/stationery . . . . . . .
Ordered other customized photo product
1
2
3
4
5
6
Have you printed digital photos in the last
600-0
Yes 1
12 months?
If yes, where printed?
Digital photo kiosk . . . . . . . . . . . . . . . . . . . . .
In-store photo center . . . . . . . . . . . . . . . . . . .
Internet/Online service . . . . . . . . . . . . . . . . . .
Home/personal photo printer . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
3
4
5
6
Types of digital photos taken, last 12 months:
599
Using
digital
camera
1
Using
smartphone/
tablet
2
Animals/Pets . . . . . . . . . . .
Family Portrait . . . . . . . . . .
Food . . . . . . . . . . . . . . . . . .
Nature/Landscape . . . . . . .
Self-Portrait . . . . . . . . . . . .
01
02
03
04
05
Special Occasions/Events .
Sports. . . . . . . . . . . . . . . . .
Vacation/Travel . . . . . . . . . .
06
07
08
TELEVISIONS, AUDIO & VIDEO EQUIPMENT,
PAY PER VIEW/VIDEO ON DEMAND
How many
television sets
does your
household own?
TELEVISION
SETS
634-0
None 1 One 2 Two 3
Three 4 Four or more 5
For each set
currently owned:
Most
Recent
Purchase
SCREEN SIZE:
2nd Most
Recent
Purchase
Other
Purchase
640-0
645-0
1
1
1
2
2
2
3
3
3
4
4
4
5
5
5
6
7
8
9
0
6
7
8
9
0
6
7
8
9
0
Projection . . . . . . . X
DLP . . . . . . . . . . . Y
X
Y
X
Y
BRANDS:
636-0
Emerson . . . . . . . . 1
Hitachi . . . . . . . . . 2
Insignia. . . . . . . . . 3
JVC. . . . . . . . . . . . 4
LG . . . . . . . . . . . . 5
Magnavox . . . . . . . 6
Panasonic. . . . . . . 7
Philips. . . . . . . . . . 8
RCA . . . . . . . . . . . 9
Samsung . . . . . . . 0
Sanyo . . . . . . . . . . X
641-0
1
2
3
4
5
646-0
1
2
3
4
5
6
7
8
9
0
X
6
7
8
9
0
X
637-0
1
2
3
4
5
6
642-0
1
2
3
4
5
6
647-0
1
2
3
4
5
6
KINDS:
Regular (tube) . . .
LCD . . . . . . . . . . .
LED . . . . . . . . . . .
OLED . . . . . . . . . .
Plasma . . . . . . . . .
Sharp . . . . . . . . . .
Sony . . . . . . . . . . .
Toshiba . . . . . . . . .
Vizio . . . . . . . . . . .
Westinghouse. . . .
Other . . . . . . . . . .
Was TV purchased in the past 12 months?
638-0
1
643-0
1
648-0
1
Yes . . . . . . . . . . . .
How much did set cost?
Less than $100. . . 2
2
2
$100-$299 . . . . . . 3
3
3
$300-$699 . . . . . . 4
4
4
$700-$999 . . . . . . 5
5
5
$1,000-$1,499 . . . 6
6
6
$1,500-$2,999 . . . 7
7
7
$3,000+ . . . . . . . . 8
8
8
Does your television set have the following:
3D TV . . . . . . . . . .
4K Ultra HDTV . . .
HDTV . . . . . . . . . .
HDTV Ready . . . .
Curved Screen . . .
639-0
1
2
3
4
5
644-0
1
2
3
4
5
Picture in Picture . 6
6
Combination
TV/DVD. . . . . . . 7
7
Closed captioning. 8
8
Smart TV/Internet
Connectable . . . 9
9
Who decided which brand to buy?
Yourself/alone or
with someone
else . . . . . . . . . . 0
0
Someone else . . . X
X
Your Household:
Bought
last 12
Owns
months
608
1
DVD or Blu-ray Player . . . . . . . 635-0
Under 27
(Small) . . . . . . .
27-35
(Medium) . . . . .
36-42
(Large) . . . . . . .
43-54
(XLarge) . . . . . .
55 and over
(XXLarge) . . . . .
DVD & BLU-RAY
PLAYERS
649-0
1
2
3
4
5
6
7
8
9
0
X
Page 48
2
01
02
03
04
KINDS:
3D . . . . . . . . . . . . . . . . . . . . .
Internet Connectable . . . . . . .
Recordable . . . . . . . . . . . . . .
Non-recordable . . . . . . . . . . .
05
06
07
08
FORMATS:
DVD . . . . . . . . . . . . . . . . . . . . Blu-ray . . . . . . . . . . . . . . . . . . 09
10
BRANDS:
LG . . . . . . . . . . . . . . . . . . . . .
Magnavox . . . . . . . . . . . . . . .
Panasonic . . . . . . . . . . . . . . .
Philips . . . . . . . . . . . . . . . . . .
Pioneer . . . . . . . . . . . . . . . . .
RCA . . . . . . . . . . . . . . . . . . . .
Samsung . . . . . . . . . . . . . . . .
Sony . . . . . . . . . . . . . . . . . . .
Toshiba . . . . . . . . . . . . . . . . .
Vizio . . . . . . . . . . . . . . . . . . . .
Other___________________
11
12
13
14
15
16
17
18
19
20
1
Headphones (ear buds) . . . .
Noise Reduction
Headphones . . . . . . . . . . .
Bluetooth/Wireless
Headphones . . . . . . . . . . .
Other Headphones . . . . . . . .
Home Theater/Entertainment
System. . . . . . . . . . . . . . . .
MP3 Player Docking Station .
Compact Disc Player. . . . . . .
Multi-Component System . . .
Receiver - amplifier . . . . . . . .
Surround Sound Speakers . .
Outdoor Speakers . . . . . . . . .
Wireless Speakers . . . . . . . .
Soundbar. . . . . . . . . . . . . . . .
Other Speakers . . . . . . . . . . .
Turntable . . . . . . . . . . . . . . . .
65H-0
2
01
02
03
04
Total amount spent, last 12 months on:
05
06
07
08
09
10
11
12
13
14
15
605
Headphones . . . . . . . . . . $
01
(Write in amount)
Other Audio Equipment . $
02
(Write in amount)
21
(Write In)
Total amount spent in last 12 months:
Less than $200 . . . . . . . . . . . 1
$200-$399 . . . . . . . . . . . . . . . 2
$400 or more. . . . . . . . . . . . . 3
Your Household:
Bought
last 12
Owns
months
603
TYPES:
Portable . . . . . . . . . . . . . . . . . Standard . . . . . . . . . . . . . . . . VCR combination . . . . . . . . . . AUDIO EQUIPMENT &
ACCESSORIES
MP3 PLAYERS
(PORTABLE)
You Personally:
Bought
last 12
Own
months
65J
1
MP3 Player . . . . . . . . . . . . . . . .
BRANDS:
Apple iPod . . . . . . . . . . . . . . .
Sansa/SanDisk . . . . . . . . . . .
Sony . . . . . . . . . . . . . . . . . . .
Other___________________
INTERNET VIDEO
DEVICES FOR TV
2
01
02
03
04
05
(Write In)
The following devices attach to your TV and
let you view video through the Internet. Which
of these, if any, does your household own?
601-0
Amazon Fire TV. . . . . . . . . . . . . . . . . . . .
Apple TV . . . . . . . . . . . . . . . . . . . . . . . . .
Google Chromecast . . . . . . . . . . . . . . . .
Google Nexus Player (Android TV) . . . . .
Netgear NeoTV . . . . . . . . . . . . . . . . . . . .
Roku . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Slingbox . . . . . . . . . . . . . . . . . . . . . . . . .
Sony Internet Player w/Google TV . . . . .
WD TV . . . . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . .
PORTABLE GPS
NAVIGATION DEVICES
(Not Factory-installed/
Not Built-In)
1
2
3
4
5
7
8
9
BRANDS:
Garmin. . . . . . . . . . . . . . . . . .
Magellan . . . . . . . . . . . . . . . .
TomTom . . . . . . . . . . . . . . . . .
Other___________________
2
1
2
3
4
5
65K-0
(Write in amount)
PAY PER VIEW/
VIDEO ON DEMAND
0
64P
Total amount spent in last
12 months: $
6
Your Household:
Bought
last 12
Owns
months
Portable GPS Navigation
1
Device . . . . . . . . . . . . . . . 64R-0
Used for:
Listening to music . . . . . . . . . . . . . . . . . .
Listening to podcasts . . . . . . . . . . . . . . . .
Watch video/movie. . . . . . . . . . . . . . . . . .
Play video game . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . .
In the past 12 months did you watch . . .?
610-0
Pay Per View (pre-set start time) . . . . . . . . . 1
Video on Demand (start at any time) . . . . . 2
Number of times you watched Pay Per View,
past 12 months: 611
Movies . . . . . . . . . . . . . . . .
01
(Write in #)
01
02
03
04
05
(Write In)
Used for:
64Q-0
Navigation in Vehicle . . . . . . . . . . . . . . . . 1
Navigation on Foot (Hiking/Walking) . . . . 2
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Sports Events . . . . . . . . . .
Other . . . . . . . . . . . . . . . . .
02
(Write in #)
03
(Write in #)
Number of times you watched Video-On-Demand,
past 30 days: 612
Movies . . . . . . . . . . . . . . . .
01
(Write in #)
TV Shows . . . . . . . . . . . . .
Music Programs/Videos. .
Other . . . . . . . . . . . . . . . . .
02
(Write in #)
03
(Write in #)
04
(Write in #)
VIDEO GAMES, BLANK RECORDABLE CDs/
DVDs/BLU-RAY DISCS, MUSIC & OTHER AUDIO
Page 49
Your Household:
Bought
last 12
Owns
months
VIDEO GAMES
(HOUSEHOLD
OWNS)
VIDEO GAMES
(PERSONALLY
PLAYED)
You Personally:
Played
Hours
last 30
played/last
days
7 days
63F
616
SYSTEMS:
Nintendo DS/DS Lite . . . . . . .
Nintendo DSi . . . . . . . . . . . . .
Nintendo DSi XL. . . . . . . . . . .
Nintendo 3DS. . . . . . . . . . . . .
Nintendo 3DS XL . . . . . . . . . .
Nintendo 2DS. . . . . . . . . . . . .
Nintendo Wii . . . . . . . . . . . . . .
Nintendo Wii U . . . . . . . . . . . .
Nintendo Wii Mini . . . . . . . . . .
PlayStation 2 (PS2) . . . . . . . .
PlayStation 3 (PS3) . . . . . . . .
PlayStation 4 (PS4) . . . . . . . .
Sony PSP/PSPgo. . . . . . . . . .
Sony PS Vita . . . . . . . . . . . . .
Xbox One . . . . . . . . . . . . . . . .
Xbox 360 . . . . . . . . . . . . . . . .
Other Video Game Systems. .
1
Who is/are the principal user(s)?
Yourself . . . . . . . . . . . . . . . . . 1
Other Adult . . . . . . . . . . . . . . 2
Teen (12-17) . . . . . . . . . . . . . 3
Child (under 12) . . . . . . . . . . 4
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
617-0
Video
63E
Video Game
Systems
Games
Where purchased,
last 12 months:
1
Video Store. . . . . . . . . . . . . . Electronics Store . . . . . . . . . GameFly. . . . . . . . . . . . . . . . GameStop . . . . . . . . . . . . . . Other Gaming Store . . . . . . . Discount Dept. Store . . . . . . Toy Store. . . . . . . . . . . . . . . . Internet/Online . . . . . . . . . . . Through game console. . . . . Other . . . . . . . . . . . . . . . . . . 2
01
02
03
04
05
06
07
08
09
10
Total amount spent, last 12 months:
Video Games
TOTAL: . . . . . . . . . . . . . . . . . . 2
618
$
01
(Write in amount)
Video Game Systems
(hardware)
$
02
(Write in amount)
Number of video games: 63W
Purchased in the last 12 months
Rented in the last 30 days
BLANK
RECORDABLE
CDs/DVDs/
BLU-RAY DISCS
01
(Write in number)
TOTAL: . . . . . . . . . . . . . . . . .
KINDS:
Blu-ray disc. . . . . . . . . . . . . .
CD . . . . . . . . . . . . . . . . . . . .
DVD . . . . . . . . . . . . . . . . . . .
BRANDS:
Fuji . . . . . . . . . . . . . . . . . . . .
Maxell . . . . . . . . . . . . . . . . . .
Memorex . . . . . . . . . . . . . . .
Panasonic. . . . . . . . . . . . . . .
Sony . . . . . . . . . . . . . . . . . . .
TDK . . . . . . . . . . . . . . . . . . .
GAME TYPES:
Action/Adventure . . . . . . . . . .
Arcade/Puzzle . . . . . . . . . . . .
Card/Board Games . . . . . . . .
Educational . . . . . . . . . . . . . .
Exercise/Fitness . . . . . . . . . .
Extreme Sports . . . . . . . . . . .
Fantasy . . . . . . . . . . . . . . . . .
Fighting . . . . . . . . . . . . . . . . .
Music/Dance . . . . . . . . . . . . .
Racing . . . . . . . . . . . . . . . . . .
Role-Playing . . . . . . . . . . . . .
Shooter . . . . . . . . . . . . . . . . .
Simulation . . . . . . . . . . . . . . .
Sports . . . . . . . . . . . . . . . . . .
Strategy . . . . . . . . . . . . . . . . .
Toys to Life . . . . . . . . . . . . . .
War . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . .
ACCESSORIES:
PlayStation Move. . . . . . . . . .
Wii Balance Board . . . . . . . . .
Xbox Kinect . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . .
FORMS:
Disc/Card/Cartridge . . . . . . .
Online Download . . . . . . . . .
Online (non-download) . . . . .
Other. . . . . . . . . . . . . . . . . . .
02
(Write in number)
You Personally:
Bought
Number
last 6
bought last
months
6 months
65F
SYSTEMS:
Nintendo DS/DS Lite . . . . . . .
Nintendo DSi . . . . . . . . . . . . .
Nintendo DSi XL . . . . . . . . . .
Nintendo 3DS . . . . . . . . . . . .
Nintendo 3DS XL. . . . . . . . . .
Nintendo 2DS . . . . . . . . . . . .
Nintendo Wii . . . . . . . . . . . . .
Nintendo Wii U. . . . . . . . . . . .
Nintendo Wii Mini . . . . . . . . . .
PlayStation 2 (PS2) . . . . . . . .
PlayStation 3 (PS3) . . . . . . . .
PlayStation 4 (PS4) . . . . . . . .
Sony PSP/PSPgo . . . . . . . . .
Sony PS Vita . . . . . . . . . . . . .
Xbox One. . . . . . . . . . . . . . . .
Xbox 360 . . . . . . . . . . . . . . . .
Other Video Game Systems. .
00
01
02
03
09
10
999
OTHER (Write In)
Used for:
Recording music . . . . . . . . . . . . . . . . . . .
Recording video. . . . . . . . . . . . . . . . . . . .
Recording photos. . . . . . . . . . . . . . . . . . .
Backing up data/software . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . .
64G-0
1
2
3
4
5
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
63G-0
1
2
3
4
You Personally:
63A
Used last
30 days
Services used, last 30 days:
Nintendo Network . . . . . . . . . . PlayStation Network . . . . . . . Xbox LIVE . . . . . . . . . . . . . . . # of times
logged in
last 7 days
01
02
03
Did you download or stream content through
any of the above online Gaming Services in the
last 30 days?
614
04
05
06
07
08
00
Streamed/ # Streamed/
Downloaded Downloaded
last 30 days last 30 days
Movie . . . . . . . . . . . . . . . . . . .
TV Show/TV Content . . . . . . .
Game Demo/Movie Trailer . . .
Game . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . .
01
02
03
04
05
Other activities, if any, done through above
online Gaming Services, last 30 days: 63J-0
Listened to Music . . . . . . . . . . . . . . . . . . 1
Accessed Social Networking site . . . . . . 2
Used IM . . . . . . . . . . . . . . . . . . . . . . . . . 3
Audio or Video Chat . . . . . . . . . . . . . . . . 4
VIDEO GAMES
(PERSONALLY
PLAYED)
(Continued)
In the last 30 days, have you played a
multi-player game online?
63J-0
Using a video game system . . . . . . . . . . 5
Using a computer . . . . . . . . . . . . . . . . . . 6
Another way . . . . . . . . . . . . . . . . . . . . . . 7
In the last 30 days, have you played a MMO
(Massive Multi-player Online) game? Yes 8
How do you find out about new video games?
63K-0
Friends . . . . . . . 1 Magazines . . . . . . . 5
Family . . . . . . . . 2 Newspapers . . . . . . 6
Radio . . . . . . . . 3 Internet . . . . . . . . . . 7
TV . . . . . . . . . . . 4 Other . . . . . . . . . . . 8
Which, if any, of the following things do you do
after you play a new video game? 63L-0
Tell friends. . . . . . . . . . . . . . . 1
Tell family . . . . . . . . . . . . . . . 2
Write about it on the Internet. 3
Other. . . . . . . . . . . . . . . . . . . 4
MUSIC & OTHER AUDIO
(Downloads, CDs, etc.)
You Personally:
Acquired
Number
acquired/last
last 6
months
6 months
632
FORMS:
Downloaded individual
song(s) . . . . . . . . . . . . . . . .
Downloaded album(s) . . . . . .
Other audio download . . . . .
Compact Disc (CD) . . . . . . .
Other (e.g. Vinyl, Cassette etc.)
64F
01
02
03
04
05
You Personally:
Listened to/ Purchased/
last 6
last 6
months
months
TYPES:
Alternative . . . . . . . . . . . . . .
Audiobooks. . . . . . . . . . . . . .
Blues . . . . . . . . . . . . . . . . . .
Classic Rock. . . . . . . . . . . . .
Classical. . . . . . . . . . . . . . . .
Contemporary Christian . . . .
Country. . . . . . . . . . . . . . . . .
Dance Music (Electronic) . . .
Dance Music (Other) . . . . . .
Easy Listening . . . . . . . . . . .
80’s Pop . . . . . . . . . . . . . . . .
Faith & Inspiration . . . . . . . .
Folk. . . . . . . . . . . . . . . . . . . .
Foreign Language
Instructional . . . . . . . . . . .
Gospel . . . . . . . . . . . . . . . . .
Hard Rock . . . . . . . . . . . . . .
Hip Hop . . . . . . . . . . . . . . . .
Indie . . . . . . . . . . . . . . . . . . .
Jazz . . . . . . . . . . . . . . . . . . .
Light Classical . . . . . . . . . . .
New Age . . . . . . . . . . . . . . . .
Oldies (50’s & 60’s) . . . . . . .
Pop/Top 40 . . . . . . . . . . . . . .
R&B . . . . . . . . . . . . . . . . . . .
Rap. . . . . . . . . . . . . . . . . . . .
Reggae. . . . . . . . . . . . . . . . .
Self-improvement . . . . . . . . .
Soft Rock . . . . . . . . . . . . . . .
Soundtracks . . . . . . . . . . . . .
Spanish/Latin . . . . . . . . . . . .
1
2
OTHER (Write In)
Where purchased:
65X-0
Book Store . . . . . . . . . . . . . . . 1
Electronics Store . . . . . . . . . . 2
Discount Dept. Store . . . . . . . 3
Music Store . . . . . . . . . . . . . . 4
Amazon Prime Music . . . . . . . 5
Google Play . . . . . . . . . . . . . . 6
iTunes. . . . . . . . . . . . . . . . . . . 7
Other Internet/Online Site. . . . 8
Other . . . . . . . . . . . . . . . . . . . 9
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
PERSONAL COMPUTERS, MOVIES & OTHER VIDEO
PERSONAL
COMPUTERS AT HOME
OR AT WORK (Continued)
PERSONAL
COMPUTERS
AT HOME OR AT WORK
Own
at Home
Use
at Work
Page 50
MOVIES &
OTHER VIDEO
(Rented or Purchased)
625
Do you or does anyone else in your household
own a personal computer?
621-0
Yes 1
No 2
Do you personally use a personal computer at
work?
No 4
Yes 3
For each computer owned at home or used at
work, is the computer a:
Own
at Home
1
Use
at Work
622
Desktop. . . . . . . . . . . . . . . . . . . Laptop/Notebook. . . . . . . . . . . . 2
01
02
Which brands does your household own and
which brands do you personally use at work?
Computer
Own
at Home
Use
at Work
1
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
Own
at Home
Use
at Work
Acer . . . . . . . . . . . . . . . . . . .
Asus . . . . . . . . . . . . . . . . . . .
Dell . . . . . . . . . . . . . . . . . . . .
Gateway . . . . . . . . . . . . . . . .
HP (Hewlett-Packard) . . . . . .
Lenovo/IBM . . . . . . . . . . . . .
Microsoft Surface Book . . . .
Panasonic. . . . . . . . . . . . . . .
Samsung . . . . . . . . . . . . . . .
Sony . . . . . . . . . . . . . . . . . .
Toshiba . . . . . . . . . . . . . . . . .
Vizio . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . .
Apple/Mac
iMac . . . . . . . . . . . . . . . . . . .
MacBook Air . . . . . . . . . . . . .
MacBook Pro . . . . . . . . . . . .
Other Apple/Mac . . . . . . . . .
Computer Peripherals
2
623
1
2
Blu-ray ROM Drive . . . . . . . . . Blu-ray RE (Blu-ray Burner) . . CD ROM Drive . . . . . . . . . . . . CD-RW Drive (CD Burner) . . DVD Drive. . . . . . . . . . . . . . . . DVD-RW Drive (DVD Burner) External Hard Drive . . . . . . . . Flash Drive . . . . . . . . . . . . . . . Modem/Fax Modem . . . . . . . . LAN/Network Interface Cards Microphone. . . . . . . . . . . . . . . Scanner . . . . . . . . . . . . . . . . . Speakers . . . . . . . . . . . . . . . . Tape/Cartridge Drive . . . . . . . Webcam . . . . . . . . . . . . . . . . . Wireless Keyboard . . . . . . . . . Wireless Mouse . . . . . . . . . . . Wireless Router . . . . . . . . . . . Other . . . . . . . . . . . . . . . . . . . Computer
Operating Systems
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
Own
at Home
1
Apple/Mac OS 9.x . . . . . . . .
Apple/Mac OS X (10.x) . . . .
Google Chrome OS
(Chromebook). . . . . . . . . .
Linux. . . . . . . . . . . . . . . . . . .
MS Windows ’98. . . . . . . . . .
MS Windows 2000 . . . . . . . .
MS Windows XP. . . . . . . . . .
MS Windows Vista . . . . . . . .
MS Windows 7 . . . . . . . . . . .
MS Windows 8 . . . . . . . . . . .
MS Windows 10 . . . . . . . . . .
Unix . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . .
Use
at Work
624
2
01
02
03
04
05
06
07
08
09
10
11
12
13
Computer Software
1
2
Accounting . . . . . . . . . . . . . .
CAD/CAM . . . . . . . . . . . . . .
Communications/Fax . . . . . .
Database/filing . . . . . . . . . . .
Desktop Publishing. . . . . . . .
01
02
03
04
05
Education/training . . . . . . . .
Entertainment/Games . . . . .
Personal finance/Tax prep . .
Presentation graphics. . . . . .
Multimedia . . . . . . . . . . . . . .
06
07
08
09
10
Networking . . . . . . . . . . . . . .
Online Meeting/Conference
Online/remote data backup .
Photo editing . . . . . . . . . . . .
Security/Anti-virus . . . . . . . .
11
12
13
14
15
Spreadsheet . . . . . . . . . . . . .
Utility . . . . . . . . . . . . . . . . . .
Web Authoring . . . . . . . . . . .
Word Processing . . . . . . . . .
Other . . . . . . . . . . . . . . . . . .
16
17
18
19
20
Amount spent for software in the past 12 months
for home:
$001 - $099 . . . . . . . . . . . . .
$100 - $199 . . . . . . . . . . . . .
$200 - $299 . . . . . . . . . . . . .
$300 - $499 . . . . . . . . . . . . .
$500 + . . . . . . . . . . . . . . . . .
626-0
1
2
3
4
5
Who decided what system to buy for your home?
628-0
someone else) . . . . . . . . . . 1
Someone else . . . . . . . . . . . . 2
Who uses the computer at home?
Yourself . . . . . . . . . . . . . . . . . . 3
Other adult . . . . . . . . . . . . . . . 4
Child (under 18) . . . . . . . . . . . 5
Have you had your home computer professionally serviced or upgraded in the last 12 months?
Yes 6
No 7
Most Recent
Purchase Other(s)
629
1
2
.........
.........
.........
.........
.........
01
02
03
04
05
$3,000 - $4,999 . . . . . . . . .
$5,000 + . . . . . . . . . . . . . . .
06
07
$0,001 - $0,499
$0,500 - $0,999
$1,000 - $1,499
$1,500 - $1,999
$2,000 - $2,999
Purchased/
last 30
days
615
FORMAT VIEWED:
DVD . . . . . . . . . . . . . . . . . . . . .
Blu-ray Disc . . . . . . . . . . . . . . .
Downloaded/Streamed from
Internet . . . . . . . . . . . . . . . . .
On-Demand/Pay-Per-View
(e.g. from cable or satellite
provider) . . . . . . . . . . . . . . .
TYPES:
Action/Adventure . . . . . . . . . .
Classics . . . . . . . . . . . . . . . . .
Comedy . . . . . . . . . . . . . . . . .
Drama . . . . . . . . . . . . . . . . . .
Exercise/Fitness . . . . . . . . . .
Family/Children-Oriented . . .
Foreign. . . . . . . . . . . . . . . . . .
Horror . . . . . . . . . . . . . . . . . .
Musical . . . . . . . . . . . . . . . . .
News/Information/
Documentary . . . . . . . . . . .
Romance . . . . . . . . . . . . . . . .
Science Fiction . . . . . . . . . . .
TV Shows . . . . . . . . . . . . . . .
Westerns . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . .
1
2
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
WHERE RENTED/PURCHASED:
Have you bought any computer books in the
last 12 months? Yes 1 627-0
Total cost of home
computer system:
You Personally:
Rented/
last 30
days
DVDs or Blu-ray Discs
Redbox . . . . . . . . . . . . . . . . .
Other video kiosk . . . . . . . . .
Video Store. . . . . . . . . . . . . .
Discount Department Store .
Electronics Store . . . . . . . . .
Grocery Store . . . . . . . . . . . .
Mail order . . . . . . . . . . . . . . .
Warehouse/Club Store . . . . .
Other Store. . . . . . . . . . . . . .
Amazon . . . . . . . . . . . . . . . .
Netflix . . . . . . . . . . . . . . . . . .
Other Website. . . . . . . . . . . .
Internet Download or Stream
Amazon . . . . . . . . . . . . . . . .
Blockbuster on Demand . . .
Cinema Now . . . . . . . . . . . .
Crackle . . . . . . . . . . . . . . . .
Google Play . . . . . . . . . . . . .
Hulu . . . . . . . . . . . . . . . . . . .
iTunes. . . . . . . . . . . . . . . . . .
Netflix . . . . . . . . . . . . . . . . . .
VUDU . . . . . . . . . . . . . . . . .
YouTube . . . . . . . . . . . . . . . .
Other Website . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . .
63Z
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
Number
Number
Rented
Purchased
Last 30 days Last 30 days
630
How Purchased:
In-store . . . . . . . . . . . . . . . .
Mail Order. . . . . . . . . . . . . .
Online/Internet . . . . . . . . . .
Phone. . . . . . . . . . . . . . . . .
1
2
01
02
03
04
05
06
07
08
09
Online-only retailer . . . . . . .
Other . . . . . . . . . . . . . . . . .
10
11
When acquired:
Within the last 12 months . .
1 - 2 years ago . . . . . . . . . .
3 - 4 years ago . . . . . . . . . .
5 years ago or more . . . . . .
12
13
14
15
Purchased from:
Computer Superstore . . . . .
Department/Discount
Store . . . . . . . . . . . . . . . .
Direct from Manufacturer . .
Electronics Store . . . . . . . .
Warehouse/Club Store . . . .
DVDs:
01
Write in #
Blu-ray discs:
02
Write in #
03
Write in #
Downloaded or
Streamed Video:
04
Write in #
05
Write in #
06
Write in #
Do you or does anyone in your household
subscribe to any of these video services?
Amazon Prime . . . . . . . . . . .
Hulu . . . . . . . . . . . . . . . . . . .
Netflix . . . . . . . . . . . . . . . . . .
PlayStation Vue . . . . . . . . . .
Sling TV . . . . . . . . . . . . . . . .
Vessel . . . . . . . . . . . . . . . . . .
Other TV network
(online-only subscription). .
63Y-0
1
2
3
4
5
6
7
COMPUTER PRINTERS/FAX/SPORTS EQUIPMENT/
CLUBS/VOTING/LOTTERY
Page 51
COMPUTER
PRINTERS AND FAX
MACHINES
Your Household:
Bought
last 12
Owns
months
1
All-in-one Printer
(Printer, Copier, Scanner) . . .
All-in-one Printer with Fax
(Printer, Copier, Scanner,
Fax) . . . . . . . . . . . . . . . . . . . . .
Computer Printer Only . . . . . .
Fax Machine Only . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . .
TYPES:
Laser . . . . . . . . . . . . . . . . . .
Ink Jet. . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . .
KINDS:
Color. . . . . . . . . . . . . . . . . . .
Black and White . . . . . . . . . .
BRANDS:
Brother . . . . . . . . . . . . . . . . .
Canon. . . . . . . . . . . . . . . . . .
Epson . . . . . . . . . . . . . . . . . .
HP . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . .
SPORT &
RECREATION
EQUIPMENT
2
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
At
home
At
club
At other
facility
01
1
2
Yes . . . . . . . . . . . . . .
3
Which of these fitness clubs/gyms, if any,
are you a member of?
Anytime Fitness . . . . . . . . . . . . . . . . . . . . .
Curves . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Gold’s Gym . . . . . . . . . . . . . . . . . . . . . . . .
LA Fitness . . . . . . . . . . . . . . . . . . . . . . . . .
Life Time Fitness . . . . . . . . . . . . . . . . . . . .
Planet Fitness . . . . . . . . . . . . . . . . . . . . . .
24 Hour Fitness . . . . . . . . . . . . . . . . . . . . .
The Y (YMCA) . . . . . . . . . . . . . . . . . . . . . .
Other Gym/Fitness Club . . . . . . . . . . . . . .
60C-0
You Personally:
Bought last
Own 12 months
Baseball gloves . . . . . . . . . .
Basketball. . . . . . . . . . . . . . .
Bicycle helmet . . . . . . . . . . .
Bow . . . . . . . . . . . . . . . . . . .
Bowling balls . . . . . . . . . . . .
01
02
03
04
05
Cross country ski boots . . . .
Cross country skis . . . . . . . .
Elbow/knee pads
(In-line skating protective gear)
Factory loaded ammunition .
Fish finder. . . . . . . . . . . . . . .
06
07
08
09
10
Fishing reel. . . . . . . . . . . . . .
Fishing rod . . . . . . . . . . . . . .
Fishing lures or hooks . . . . .
Other fishing equipment . . . .
Football. . . . . . . . . . . . . . . . .
11
12
13
14
15
Golf balls . . . . . . . . . . . . . . .
Outdoor or pocket knife . . . .
Racquetball balls . . . . . . . . .
Racquetball racquet . . . . . . .
Soccer ball . . . . . . . . . . . . . .
16
17
18
19
20
Softball/baseball bats. . . . . .
Sportswatch/Chronograph . .
Tennis balls . . . . . . . . . . . . .
Tennis racquet . . . . . . . . . . .
Binoculars. . . . . . . . . . . . . . .
21
22
23
24
25
Mountain bicycle. . . . . . . . . .
Road bicycle. . . . . . . . . . . . .
Stationary bicycle . . . . . . . . .
Downhill ski boots. . . . . . . . .
Downhill skis. . . . . . . . . . . . .
26
27
28
29
30
Roller blades/In-line skates .
Elliptical . . . . . . . . . . . . . . . .
Treadmill . . . . . . . . . . . . . . . .
Other exercise equipment . .
Golf clubs . . . . . . . . . . . . . . .
31
32
33
34
35
Hand gun . . . . . . . . . . . . . . .
Rifle . . . . . . . . . . . . . . . . . . .
Shotgun . . . . . . . . . . . . . . . .
Hockey equipment . . . . . . . .
Weight lifting equipment . . . .
Other . . . . . . . . . . . . . . . . . .
36
37
38
39
40
41
1
2
Amount spent on sport & recreation equipment,
last 12 months: $
(Write in amount)
60B-0
1
2
3
4
5
6
7
8
9
You Personally:
Bought
Times
in last
last 30
12 months
days
You Personally:
Bought
Number of
in last
cards last
6 months
30 days
LOTTERY
658
KINDS:
Instant game (Scratch-off) . .
Daily drawing . . . . . . . . . . . .
Mega Millions . . . . . . . . . . . .
Powerball . . . . . . . . . . . . . . .
Other Lotto or drawing
game. . . . . . . . . . . . . . . . .
00
01
02
04
Always Sometimes Never
1
2
3
Types of Organizations:
655-0
Public Broadcasting Service (PBS) .
National Public Radio (NPR) . . . . . .
Religious. . . . . . . . . . . . . . . . . . . . . .
Arts/Cultural . . . . . . . . . . . . . . . . . . .
Educational . . . . . . . . . . . . . . . . . . .
1
2
3
4
5
Environmental . . . . . . . . . . . . . . . . .
Health. . . . . . . . . . . . . . . . . . . . . . . .
Political . . . . . . . . . . . . . . . . . . . . . . .
Social Services. . . . . . . . . . . . . . . . .
Other Non-Religious Organization . .
6
7
8
9
0
63M-0
How much did you
contribute in total?
01
02
03
You Personally:
Contributed to,
last 12 months
CONTRIBUTIONS
00
01
02
03
04
05
Thinking of You . . . . . . . . . . .
Wedding . . . . . . . . . . . . . . . .
Baby . . . . . . . . . . . . . . . . . . .
Christmas/Hanukkah/
Kwanzaa . . . . . . . . . . . . . .
Mother’s Day . . . . . . . . . . . .
06
07
08
09
10
Father’s Day . . . . . . . . . . . . .
Valentine’s Day . . . . . . . . . . .
Other Holiday . . . . . . . . . . . .
Other Occasion . . . . . . . . . .
Where Purchased:
Card Store . . . . . . . . . . . . . . . . . . . . . . . .
Discount Department Store . . . . . . . . . . .
Dollar Store . . . . . . . . . . . . . . . . . . . . . . .
Drug Store . . . . . . . . . . . . . . . . . . . . . . . .
Grocery Store . . . . . . . . . . . . . . . . . . . . .
Internet/Online . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . .
CASINO
GAMBLING
11
12
13
14
999
63N-0
1
2
3
4
5
6
7
You Personally:
Participated
Times
in last
last 12
12 months
months
659
POLOTICAL OUTLOOK
National Elections . . . . . .
Statewide Elections . . . . .
Local Elections . . . . . . . .
TYPES:
Anniversary . . . . . . . . . . . . .
Birthday . . . . . . . . . . . . . . . .
Friendship/Love . . . . . . . . . .
Get Well . . . . . . . . . . . . . . . .
Sympathy . . . . . . . . . . . . . . .
05
999
65G
How often you vote:
................. 03
OTHER (Write In)
VOTING
TOTAL:
OTHER (Write In)
Any lottery tickets:. . . . . . . . . 667
GREETING CARDS
657
656-0
631
In the last 12 months,
have you exercised
regularly (at least
twice a week)?
PHYSICAL FITNESS
PLACES:
Atlantic City . . . . . . . . . . . . .
Caribbean. . . . . . . . . . . . . . .
Connecticut . . . . . . . . . . . . .
Las Vegas. . . . . . . . . . . . . . .
Mississippi Gulf Coast . . . . .
Reno. . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . .
01
02
03
04
05
06
07
ORGANIZATIONS/
CLUBS
Organizations or clubs you are a member of:
653-0
AARP . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Fraternal Orders. . . . . . . . . . . . . . . . . . . . .
Religious Clubs . . . . . . . . . . . . . . . . . . . . .
Civic Clubs. . . . . . . . . . . . . . . . . . . . . . . . .
Veterans Clubs. . . . . . . . . . . . . . . . . . . . . .
A body of local government . . . . . . . . . . . .
1
2
3
4
5
6
654-0
1
2
3
4
5
Country Clubs . . . . . . . . . . . . . . . . . . . . . .
Business Club . . . . . . . . . . . . . . . . . . . . . .
Collector’s Clubs . . . . . . . . . . . . . . . . . . . .
Union . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
School or College Board . . . . . . . . . . . . . .
Church Board. . . . . . . . . . . . . . . . . . . . . . . Charitable Organizations . . . . . . . . . . . . . . Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Amount
$1-$49 . . . . . . . . . . .
$50-$99 . . . . . . . . . .
$100-$249 . . . . . . . .
$250-$499 . . . . . . . .
$500 or more . . . . . .
1
2
3
4
5
In the past 12 months, have you volunteered
for a charitable organization?
Yes
6
HOBBIES
6
7
8
Do you engage in
any of the following
activities?
Collecting - antiques. . . . . . . . . . . . . . . . . .
Collecting - art . . . . . . . . . . . . . . . . . . . . . .
Collecting - coins . . . . . . . . . . . . . . . . . . . .
Collecting - comic books . . . . . . . . . . . . . .
Collecting - dolls/action figures. . . . . . . . . .
Collecting - figurines. . . . . . . . . . . . . . . . . .
Collecting - stamps. . . . . . . . . . . . . . . . . . .
Collecting - sports trading cards. . . . . . . . .
Collecting - watches . . . . . . . . . . . . . . . . . .
Indoor gardening & plants . . . . . . . . . . . . .
Listen to music . . . . . . . . . . . . . . . . . . . . . .
Raising pets . . . . . . . . . . . . . . . . . . . . . . . .
663-0
1
2
3
4
5
6
7
8
9
0
X
Y
65E-0
Tropical fish . . . . . . . . . . . . . . . . . . . . . . . . 1
LEISURE ACTIVITIES/SOCIAL NETWORKING
HOW OFTEN DO YOU ENGAGE IN THESE:
You Personally:
LEISURE
ACTIVITIES
Participated
in last
12 months
662
1
Page 52
2 or more
times a
week
Once a
week
2
2-3
times a
month
3
4
Once a
month
5
Less than
once a
month
6
Adult education courses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Aquarium attendance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Attend auto shows . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Attend art galleries or shows . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Attend horse races . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
01
02
03
04
05
Attend country music performances. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Attend rock music performances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Attend classical music/opera performances . . . . . . . . . . . . . . . . . . . . . . . .
Attend other music performances. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Attend dance performances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
06
07
08
09
10
Attend a circus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Attend a state or county fair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Baking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Barbecuing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Go to bars/night clubs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11
12
13
14
15
Go to beach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Billiards/pool . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Birdwatching. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Board games . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Book clubs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16
17
18
19
20
Chess . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Cooking for fun . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Concerts on radio. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Crossword puzzles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Dance/go dancing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
21
22
23
24
25
Dining out . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Entertain friends or relatives at home. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Fantasy sports league . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Film/produce videos . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Furniture refinishing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
26
27
28
29
30
Home decoration and furnishing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Karaoke . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Go to live theater . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Go to museums . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Painting, drawing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
31
32
33
34
35
Photography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Photo Album/Scrapbooking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Picnic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Play bingo. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Play cards. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
36
37
38
39
40
Play musical instrument . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Reading books . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Reading comic books . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Sudoku Puzzles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Tailgating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
41
42
43
44
45
Word games . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Trivia games . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
PC/computer games (play online) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
PC/computer games (play offline with software) . . . . . . . . . . . . . . . . . . . .
Video/electronic games (console) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
46
47
48
49
50
Video/electronic games (portable) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Woodworking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Zoo attendance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
51
52
53
SOCIAL
NETWORKING
In the last 30 days, have you visited or used a social-networking website?
60E-0
Yes 1
How important to you, personally, are the following reasons for visiting or using a social-networking website?
60F
Reasons for using a Social Networking site:
Keep in touch with family/friends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Reconnect with people from my past . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Meet new friends. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Follow the activities of my friends and family . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Find out about products and services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Rate or review a product or service. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Meet or network with professional contacts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Find people who have interests similar to me . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Find information about news or other current events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Find information about a movie, TV station or show . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Find local information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Play games . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
To show support for my favorite companies or brands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
To receive exclusive offers, coupons or other discounts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
To gain access to VIP or Members-Only events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Not at all
Important
Not Very
Important
Somewhat
Important
1
2
3
Very
Important
4
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
SPORTS
Page 53
HOW OFTEN DO YOU ENGAGE IN THESE:
You Personally:
SPORTS
Participated
in last
12 months
666
2 or more
times a
week
Once a
week
2-3
times a
month
Once a
month
Less than
once a
month
1
2
3
4
5
6
Aerobics .....................................................................................................
Archery .......................................................................................................
Auto racing .................................................................................................
Backpacking ...............................................................................................
Baseball .....................................................................................................
01
02
03
04
05
Basketball ...................................................................................................
Bicycling – Mountain ..................................................................................
Bicycling – Road.........................................................................................
Boating (power) ..........................................................................................
Bowling .......................................................................................................
06
07
08
09
10
Canoeing/kayaking .....................................................................................
Fishing – fresh water ..................................................................................
Fishing – salt water ....................................................................................
Football.......................................................................................................
Frisbee .......................................................................................................
11
12
13
14
15
Golf.............................................................................................................
Hiking .........................................................................................................
Hockey .......................................................................................................
Horseback riding ........................................................................................
Hunting with bow & arrow...........................................................................
16
17
18
19
20
Hunting with handgun ................................................................................
Hunting with rifle .........................................................................................
Hunting with shotgun ..................................................................................
Ice skating ..................................................................................................
Jet skiing ....................................................................................................
21
22
23
24
25
Jogging/running..........................................................................................
Karate .........................................................................................................
Kick Boxing.................................................................................................
Marathon/Triathlon (training and events) ...................................................
Martial Arts .................................................................................................
26
27
28
29
30
Motocross ...................................................................................................
Motorcycling ...............................................................................................
Paintball......................................................................................................
Pilates.........................................................................................................
Ping Pong/Table Tennis ..............................................................................
31
32
33
34
35
Racquetball ................................................................................................
Rock climbing .............................................................................................
Roller blading/in-line skating ......................................................................
Roller skating..............................................................................................
Rowing: stationary/outdoor.........................................................................
36
37
38
39
40
Sailing.........................................................................................................
Scuba diving ...............................................................................................
Skateboarding ............................................................................................
Skiing – Cross country ...............................................................................
Skiing – Downhill ........................................................................................
41
42
43
44
45
Snorkeling/skin diving ................................................................................
Snowboarding ............................................................................................
Snowmobiling .............................................................................................
Soccer ........................................................................................................
Softball .......................................................................................................
46
47
48
49
50
Spinning .....................................................................................................
Surfing/windsurfing .....................................................................................
Swimming ...................................................................................................
Target shooting ...........................................................................................
Tennis .........................................................................................................
51
52
53
54
55
Volleyball ....................................................................................................
Wakeboarding ............................................................................................
Walking for exercise ...................................................................................
Water skiing ................................................................................................
Weight lifting ...............................................................................................
56
57
58
59
60
Whitewater rafting .......................................................................................
Yoga ...........................................................................................................
Zumba ........................................................................................................
Other ..........................................................................................................
61
62
63
64
TELEPHONES/PHONE CALLS/CELL PHONE APPS & OPINIONS/
WEARABLE TECH
Your Household
HOME PHONE &
ACCESSORIES
(Landline phone)
Owns
669
1
2
In-Home Telephone: . . . . . .
BRANDS:
AT&T . . . . . . . . . . . . . . . . .
General Electric . . . . . . . . .
Motorola . . . . . . . . . . . . . . .
Panasonic . . . . . . . . . . . . .
Uniden . . . . . . . . . . . . . . . .
01
02
03
04
05
06
Vtech . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . .
07
08
Telephone Accessories:
Answering Machine . . . . . .
Telephone Headset . . . . . .
Wireless Headphones . . . .
09
10
11
Which of the following services is your
670-0
household using?
Call forwarding. . . . . . . . . . . . . . . . .
1
Call return . . . . . . . . . . . . . . . . . . . .
2
Call waiting . . . . . . . . . . . . . . . . . . .
3
Caller ID. . . . . . . . . . . . . . . . . . . . . .
4
Repeat dialing . . . . . . . . . . . . . . . . .
5
Three-way calling. . . . . . . . . . . . . . .
6
Voice messaging/Voice mail . . . . . .
7
TELEPHONE
CALLING CARDS/
PRE-PAID CARDS
674
Did you personally make a collect call in the
last 6 months?
Yes 1
65A-0
LOCAL & LONG
DISTANCE CALLS
(Personal calls only)
Average monthly landline phone bill:
$11-$15 . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$16-$25 . . . . . . . . . . . . . . . . . . . . . . . . . . .
$26-$59 . . . . . . . . . . . . . . . . . . . . . . . . . . .
$60-$99 . . . . . . . . . . . . . . . . . . . . . . . . . . .
$100 or more . . . . . . . . . . . . . . . . . . . . . . .
1
2
3
4
5
65D
Local
01
02
03
04
05
Time Warner . . . . . . . . .
Verizon . . . . . . . . . . . . .
Vonage . . . . . . . . . . . . .
Other ______________
06
07
08
09
(Write In)
65M
Local. . . . . . . . . . . . . . . . . . . .
01
(Write in Number)
Long Distance within the US . .
02
(Write in Number)
Business ____________________________ 01
International Long Distance . .
(Write in Number)
03
(Write in Number)
Personal _____________________________ 02
(Write in Number)
Have you purchased or refilled a pre-paid calling
card in the last 12 months?
677-0
Yes 1
CELLULAR/
MOBILE OPINIONS
to how you feel.
DISAGREE
AGREE
Completely
61K
1. I carry my cell phone everywhere I go. . . . . . . . . . . .
2. I will always keep a household (landline) telephone,
no matter how much cell phone service improves.
3. I am frequently annoyed at people talking too
loudly on their cell phones in public places. . . . . .
4. I only answer my cell phone when I know who is calling.
5. I often use my cell phone to make phone calls from
my home. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6. The primary reason I have my cell phone is for
safety. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7. Sometimes my cell phone makes me feel like
I’m too available. . . . . . . . . . . . . . . . . . . . . . . . . . .
8. Cell phones are too complicated these days. . . . . . .
Somewhat
Somewhat
1
2
3
01
02
03
04
05
06
07
08
How important to you are the following features when choosing a mobile phone service
provider?
61M
1. Customer Service . . . . . . . . . . . . . . . . . . . . . . .
2. Phone Models Available . . . . . . . . . . . . . . . . . .
3. Service Coverage Area . . . . . . . . . . . . . . . . . . .
4. Service Plans Available . . . . . . . . . . . . . . . . . . .
Type of
Apps you
personally
used last
30 days
CELL/MOBILE
PHONE “APPS”
Not
Important
Somewhat
Important
Very
Important
1
2
3
01
02
03
04
1
2
3
4
5
6
7
8
9
Apps/
activities
you would
miss if
unavailable
680
2
AT&T. . . . . . . . . . . . . . .
CenturyLink . . . . . . . . .
Comcast/Xfinity . . . . . .
Cox . . . . . . . . . . . . . . . .
magicJack . . . . . . . . . .
Number of calls you made, last 30 days:
Using your calling card, what is the average
number of calls you personally make each
month for:
675
FitBit . . . . . . . . . . . . . . . . . . . . . . .
Jawbone . . . . . . . . . . . . . . . . . . . .
Other wristband fitness tracker . . .
Other wearable fitness tracker . . . .
Apple Watch . . . . . . . . . . . . . . . . . .
Samsung Galaxy Gear . . . . . . . . . .
Other Smartwatch . . . . . . . . . . . . .
Smart Eyeglasses . . . . . . . . . . . . .
Other Wearable Tech . . . . . . . . . . .
Long Distance
1
2
01
02
65B-0
Phone services used (landline):
You Personally
Own
668-0
(Write in number)
CALLING/PRE-PAID CARDS:
1
Wearable Tech are devices that are worn, may
connect to the Internet and can synchronize
with other devices, such as a smartphone or
computer.
Number of collect calls made, last 6 months:
_______________ 65C-0
You Personally:
Acquired
last 12
Have months
AT&T . . . . . . . . . . . . . . . . . . . . . Other . . . . . . . . . . . . . . . . . . . . . WEARABLE TECH
(Smartwatches,
Fitness Trackers, etc.)
COLLECT
CALLS
Bought
last 12
months
Page 54
Completely
4
TYPE OF APPS:
Banking/Finance . . . . . .
Books . . . . . . . . . . . . . .
Calendar/Schedule . . . .
“Daily Deal” . . . . . . . . . .
Dating . . . . . . . . . . . . . .
01
02
03
04
05
Education . . . . . . . . . . .
Email . . . . . . . . . . . . . . .
Fitness . . . . . . . . . . . . .
Food/Cooking . . . . . . . .
Games . . . . . . . . . . . . .
06
07
08
09
10
Healthcare . . . . . . . . . .
Local Information . . . . .
Magazine . . . . . . . . . . .
Movies . . . . . . . . . . . . .
Music (to listen) . . . . . . .
11
12
13
14
15
Music Store
(to purchase) . . . . . . .
Navigation/Maps . . . . . .
News . . . . . . . . . . . . . . .
Newspaper . . . . . . . . . .
Photography . . . . . . . . .
16
17
18
19
20
Reference . . . . . . . . . . .
Rideshare/Taxi . . . . . . .
Shopping/Retail. . . . . . .
Sports . . . . . . . . . . . . . .
Social Networking . . . . .
21
22
23
24
25
Text . . . . . . . . . . . . . . . .
TV/Cable . . . . . . . . . . . .
Travel. . . . . . . . . . . . . . .
Video (e.g. short
video clips) . . . . . . . .
Weather . . . . . . . . . . . .
26
27
28
29
30
Other Entertainment . . .
Other ______________
31
32
1
2
(Write In)
Number of Apps
downloaded for free,
last 30 days:
681
01
(Write in Number)
Number of Apps
purchased, last
30 days:
02
(Write in Number)
Amount spent on
Apps, last 30 days:
$
03
(Write in Amount)
CELLULAR/MOBILE PHONES
Page 55
You Personally:
705-0
Have a working cellular/mobile phone . . . . . 1
Purchased/obtained last 12 months. . . . . . . 2
Working cell phones
you personally:
709
Use most Other working
often
cell phone(s)
(choose one
brand)
Handset Brands:
Amazon Fire Phone . . . . .
Apple iPhone . . . . . . . . . .
BlackBerry . . . . . . . . . . . .
Casio . . . . . . . . . . . . . . . .
HTC . . . . . . . . . . . . . . . . .
01
02
03
04
05
Kyocera . . . . . . . . . . . . . .
LG . . . . . . . . . . . . . . . . . .
Microsoft . . . . . . . . . . . . .
Motorola. . . . . . . . . . . . . .
Nexus. . . . . . . . . . . . . . . .
06
07
08
09
10
Nokia . . . . . . . . . . . . . . . .
Samsung . . . . . . . . . . . . .
Sony . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . .
11
12
13
14
Used For:
Business . . . . . . . . . . . . .
Personal. . . . . . . . . . . . . .
15
16
1
2
Plan Types:
Individual Plan . . . . . . . . . . . . . . . . . . . . . . .
Family or Shared Plan . . . . . . . . . . . . . . . . .
Corporate Plan . . . . . . . . . . . . . . . . . . . . . .
Amount spent on cellular phone
purchase, last 12 months: $
61F-0
(Write in Amount)
Where Purchased:
707-0
Online/Internet . . . . . . . . . . . . . . . . . . . . . . 1
Electronics Store . . . . . . . . . . . . . . . . . . . . 2
Department Store . . . . . . . . . . . . . . . . . . . 3
Discount Store . . . . . . . . . . . . . . . . . . . . . . 4
Wholesale/Club Store . . . . . . . . . . . . . . . . 5
Carrier-owned Store. . . . . . . . . . . . . . . . . . 6
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Cell Phone
Has
1
Please answer the following questions about the
one cell phone you personally use most often:
61G-0
1
2
3
Mobile Service Agreement Types:
Monthly Plan with Contract . . . . . . . . . . . . .
Monthly Plan with No Contract . . . . . . . . . .
Prepaid . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
5
6
Average Monthly Bill:
$ 1-$24 . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$25-$49 . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$50-$74 . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$75-$99 . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$100-$199 . . . . . . . . . . . . . . . . . . . . . . . . . .
$200+ . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
8
9
0
X
Y
CELLULAR/
MOBILE OPINIONS
CELLULAR/
MOBILE PHONES/
SMARTPHONES
(Continued)
CELLULAR/
MOBILE PHONES/
SMARTPHONES
(Continued)
CELLULAR/
MOBILE PHONES/
SMARTPHONES
Personally
Used last
30 days
708
2
Communication Features:
Phone. . . . . . . . . . . . . . . . . . .
Voicemail . . . . . . . . . . . . . . . .
Email . . . . . . . . . . . . . . . . . . .
Text Messaging . . . . . . . . . . .
Picture Messaging . . . . . . . . .
Google Android OS. . . . . . . . .
Windows Mobile/Phone OS . .
01
02
03
04
05
06
07
Media Features:
Camera . . . . . . . . . . . . . . . . .
Games . . . . . . . . . . . . . . . . . .
MP3 Player. . . . . . . . . . . . . . .
Video Player. . . . . . . . . . . . . .
Video Recorder . . . . . . . . . . .
Web/Internet Access . . . . . . .
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
Other Features:
Alarm Clock . . . . . . . . . . . . . .
Bluetooth . . . . . . . . . . . . . . . .
Calendar/Organizer . . . . . . . .
GPS/Navigation . . . . . . . . . . .
View Spreadsheets/
Text Documents . . . . . . . . .
Create/Edit Spreadsheets/
Text Documents . . . . . . . . .
Speakerphone . . . . . . . . . . . .
Voice Activated Dialing . . . . . .
WiFi . . . . . . . . . . . . . . . . . . . .
Which, if any, of the following things did you
do using your cell phone in the last 30 days?
Visited a search engine . . . . . . . . . . . . . . .
Visited a website for News . . . . . . . . . . . . .
Visited a website for Sports . . . . . . . . . . . .
Visited a website for Weather. . . . . . . . . . .
Visited a website for Entertainment
Information . . . . . . . . . . . . . . . . . . . . . . .
Visited a website for Financial Information
Visited a website for Maps/Directions . . . . . . .
Visited a website for other Local Information .
Visited or used a Social Networking site. . . . .
Searched for information about a product . .
Visited any other website . . . . . . . . . . . . . .
Used Text Messaging to communicate
with friends or family . . . . . . . . . . . . . . .
Used Text Messaging to vote in a contest,
make a choice, or give an opinion . . . . .
Looked at an advertisement sent with
Text Message . . . . . . . . . . . . . . . . . . . . .
Used Text Messaging to respond to an
advertisement . . . . . . . . . . . . . . . . . . . . .
Purchased a product . . . . . . . . . . . . . . . . . .
Signed up for a Text Message “alert” service
Received a Text Message “alert” . . . . . . . .
Redeemed a mobile coupon . . . . . . . . . . .
Scanned a QR code or other “Tag” . . . . . .
Used a mobile wallet . . . . . . . . . . . . . . . . .
Watched a video clip . . . . . . . . . . . . . . . . .
Watched a downloaded or streamed
TV program . . . . . . . . . . . . . . . . . . . . . . .
Watched live television. . . . . . . . . . . . . . . .
62Z-0
1
2
3
4
5
6
7
8
9
0
X
Y
61H-0
1
2
3
4
5
6
7
8
9
0
X
Y
61J-0
Watched a full length movie . . . . . . . . . . . .
Watched other video . . . . . . . . . . . . . . . . .
Listened to a podcast. . . . . . . . . . . . . . . . .
Listened to music . . . . . . . . . . . . . . . . . . . .
Listened to radio . . . . . . . . . . . . . . . . . . . .
Downloaded a song . . . . . . . . . . . . . . . . . .
Downloaded a ringtone . . . . . . . . . . . . . . .
Downloaded wallpaper. . . . . . . . . . . . . . . .
Downloaded a game . . . . . . . . . . . . . . . . .
Downloaded an application or “App”. . . . . .
Used an application or “App” . . . . . . . . . . .
Called directory assistance . . . . . . . . . . . .
1
2
3
4
5
6
7
8
9
0
X
Y
Made or received a video call . . . . . . . . . .
1
62X-0
to how you feel.
62H
DISAGREE
Completely
Somewhat
AGREE
Somewhat Completely
1
2
3
I understand how to use most of the features on my cell phone. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Having one mobile device that can do everything is very convenient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
There are some features on my cell phone I’d like to use, but I don’t know how to use them. . . . . . . . . . . . . .
I just want to use my cell phone to make and receive calls and don’t care about any other features.. . . . . . . .
I think of my mobile phone as a source of entertainment.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6. My cell phone is an extension of my personality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7. I enjoy customizing the look and sound of my cell phone. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8. I would be willing to receive advertisements on my cell phone in exchange for services, like live TV
or Text Messaging.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9. I would be willing to pay a monthly subscription fee to receive live TV on my cell phone. . . . . . . . . . . . . . . . .
10. I would be willing to receive advertisements on my cell phone in exchange for lower monthly costs. .. . . . . . .
11.
12.
13.
14.
15.
I like to receive coupons on my cell phone that are based on my location.. . . . . . . . . . . . . . . . . . . . . . . . . . . .
I expect the quality of video on my cell phone to be as good as that on my TV. . . . . . . . . . . . . . . . . . . . . . . .
Advertisements on cell phones are annoying.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I am interested in watching video clips on my cell phone.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I am interested in watching live TV on my cell phone. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16.
17.
18.
19.
20.
21.
22.
Text messaging is an important part of my daily life. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I would use Text Messaging if I knew how to do it. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I would use Text Messaging more often, if it were easier to type the messages. . . . . . . . . . . . . . . . . . . . . . . .
I would use Text Messaging more often, if it were less expensive. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I would use the Internet on my cell phone more often, if it were less expensive. . . . . . . . . . . . . . . . . . . . . . . .
I would use the Internet on my cell phone more often, if the websites loaded more easily. . . . . . . . . . . . . . . .
I would use the Internet on my cell phone more often, if the screen were easier to read.. . . . . . . . . . . . . . . . .
1.
2.
3.
4.
5.
4
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
TABLETS & E-READERS
You Personally:
Bought
Last 12
Months
Own
TABLETS &
E-READERS
701
BRANDS:
1
Amazon Kindle (e-reader) . . .
Amazon Kindle Fire (tablet) . .
Apple iPad (any standard
size or larger model) . . . . . .
Apple iPad mini. . . . . . . . . . . .
Barnes & Noble Nook
(e-reader) . . . . . . . . . . . . . .
Barnes & Noble Nook Color/HD
(tablet). . . . . . . . . . . . . . . . .
Google Nexus (tablet) . . . . . .
Microsoft Surface (tablet) . . . .
Samsung Galaxy Tab/
Galaxy Note (tablet) . . . . . .
Samsung Galaxy Tab 4 Nook
Other Tablet . . . . . . . . . . . . . .
Other E-Reader . . . . . . . . . . .
2
01
02
03
04
05
06
07
08
09
10
11
12
702
Total cost of Tablet(s) or E-reader(s),
purchased last 12 months:
$
01
(Write in Amount)
Total time spent using your Tablet and/or
E-reader, last 7 days:
Tablet/E-reader:
hours used,
last 7 days
Page 56
TABLETS &
E-READERS
(Continued)
Who uses your tablet?
1
2
3
4
5
6
7
703-0
Read a book . . . . . . . . . . . . . . . . . . . . . . . .
Read a magazine . . . . . . . . . . . . . . . . . . . .
Read a newspaper . . . . . . . . . . . . . . . . . . .
Read or sent an e-mail . . . . . . . . . . . . . . . .
1
2
3
4
Watched a movie . . . . . . . . . . . . . . . . . . . .
Watched a TV show . . . . . . . . . . . . . . . . . .
Watched other video . . . . . . . . . . . . . . . . . .
Played a single-player game . . . . . . . . . . . .
Played a multi-player game. . . . . . . . . . . . .
5
6
7
8
9
Visited Facebook. . . . . . . . . . . . . . . . . . . . .
Visited other social networking site . . . . . . .
0
X
61L-0
Visited a search engine. . . . . . . . . . . . . . . .
Visited other website . . . . . . . . . . . . . . . . . .
Obtained information on news
or current events . . . . . . . . . . . . . . . . . . . .
Obtained information about sports . . . . . . .
Obtained financial information . . . . . . . . . .
Obtained information about the weather. . .
1
2
Obtained information on travel . . . . . . . . . .
Obtained local information . . . . . . . . . . . . .
Purchased a product or service . . . . . . . . .
Listened to music . . . . . . . . . . . . . . . . . . . .
Downloaded music . . . . . . . . . . . . . . . . . . .
Listened to/watched a podcast . . . . . . . . . .
7
8
9
0
X
Y
3
4
5
6
61P-0
Took a picture or video . . . . . . . . . . . . . . . .
Uploaded photos. . . . . . . . . . . . . . . . . . . . .
Used a map/navigation program . . . . . . . .
Made or received a video call . . . . . . . . . . .
1
2
3
4
Other
5
_________________________________________
(Write In)
TYPE OF APPS:
Banking/Finance . . . . . .
Books . . . . . . . . . . . . . .
Calendar/Schedule . . . .
“Daily Deal” . . . . . . . . . .
Dating . . . . . . . . . . . . . .
01
02
03
04
05
Education . . . . . . . . . . .
Email . . . . . . . . . . . . . . .
Fitness . . . . . . . . . . . . .
Food/Cooking . . . . . . . .
Games . . . . . . . . . . . . .
06
07
08
09
10
Healthcare . . . . . . . . . .
Local Information . . . . .
Magazine . . . . . . . . . . .
Movies . . . . . . . . . . . . .
Music (to listen) . . . . . . .
11
12
13
14
15
Music Store
(to purchase) . . . . . . .
Navigation/Maps . . . . . .
News . . . . . . . . . . . . . . .
Newspaper . . . . . . . . . .
Photography . . . . . . . . .
16
17
18
19
20
Reference . . . . . . . . . . .
Rideshare/Taxi . . . . . . .
Shopping/Retail. . . . . . .
Sports . . . . . . . . . . . . . .
Social Networking . . . . .
21
22
23
24
25
Text . . . . . . . . . . . . . . . .
TV/Cable . . . . . . . . . . . .
Travel. . . . . . . . . . . . . . .
Video (e.g. short
video clips) . . . . . . . .
Weather . . . . . . . . . . . .
26
27
28
29
30
Other Entertainment . . .
Other ______________
31
32
1
2
(Write In)
61U-0
Yourself . . . . . . . . . . . . . . . . . . . . . . .
Other adult . . . . . . . . . . . . . . . . . . . .
Child (under 18) . . . . . . . . . . . . . . . .
Apps/
activities
you would
miss if
unavailable
61D
Activities you have done using a Tablet or
E-reader, last 30 days:
61Q-0
None. . . . . . . . . . . . . . . . . . . . . . . . .
Less than 1 hour . . . . . . . . . . . . . . .
1-4 hours. . . . . . . . . . . . . . . . . . . . . .
5-9 hours . . . . . . . . . . . . . . . . . . . . .
10-19 hours . . . . . . . . . . . . . . . . . . .
20-29 hours . . . . . . . . . . . . . . . . . . .
30 hours or more . . . . . . . . . . . . . . .
Type of
Apps you
personally
used last
30 days
TABLETS &
E-READERS
(Continued)
1
2
3
Number of Apps
downloaded for free,
last 30 days:
61V
01
(Write in Number)
Number of Apps
purchased, last
30 days:
02
(Write in Number)
Amount spent on
Apps, last 30 days:
MORE
MOBILE OPINIONS
to how you feel.
62U
$
61E-0
(Write in Amount)
DISAGREE
Completely
Somewhat
AGREE
Somewhat Completely
1
2
3
1.
2.
3.
4.
5.
On my tablet, I prefer to use apps instead of websites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
On my cell phone, I prefer to use apps instead of websites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I often use my mobile device inside a store to get information about the products sold there . . . . . . . . . . . . .
I often use my mobile device inside a store to help me make purchase decisions . . . . . . . . . . . . . . . . . . . . . .
I often use my mobile device inside a store to look for coupons or other offers . . . . . . . . . . . . . . . . . . . . . . . .
4
6.
7.
8.
9.
10.
11.
12.
13.
I often use my mobile device to compare prices before making a purchase . . . . . . . . . . . . . . . . . . . . . . . . . .
Mobile apps are updated too frequently . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
My mobile device greatly improves my daily commute . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Whenever I am going somewhere new, I rely on my phone/mobile device to help me get there . . . . . . . . . . .
Checking my phone is the first thing I do in the morning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I’m always checking out the app store to see what’s new . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I text more than I talk on my phone. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Apps have made my life so much more convenient.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
01
02
03
04
05
06
07
08
09
10
11
12
13
SPORTS EVENTS, GARDENING, EXTERMINATORS
Page 57
SPORTS EVENTS:
WATCH, LISTEN &
ATTEND
Did you watch on TV, listen to on the radio or attend in-person any
of these sports events: 1) in the last 12 months and if so, 2) regularly
during the sport’s season?
WATCHED ON TV
Last 12
months
682
Alpine Skiing & Ski Jumping. . . . . . . .
Auto Racing – NASCAR . . . . . . . . . . .
Auto Racing – Other. . . . . . . . . . . . . .
Baseball – College . . . . . . . . . . . . . . .
Baseball – MLB Regular Season . . . .
Baseball – MLB Playoffs/World Series . .
Basketball – College. . . . . . . . . . . . . .
Basketball – NBA Regular Season. . .
Basketball – NBA Playoffs/Finals . . . .
Basketball – NCAA Basketball
Tournament. . . . . . . . . . . . . . . . . . .
Basketball – WNBA . . . . . . . . . . . . . .
Bicycle Racing . . . . . . . . . . . . . . . . . .
Bowling. . . . . . . . . . . . . . . . . . . . . . . .
Boxing . . . . . . . . . . . . . . . . . . . . . . . .
Equestrian Events . . . . . . . . . . . . . . .
Extreme Sports – Summer. . . . . . . . .
Extreme Sports – Winter . . . . . . . . . .
Figure Skating . . . . . . . . . . . . . . . . . .
Fishing . . . . . . . . . . . . . . . . . . . . . . . .
Football – College . . . . . . . . . . . . . . .
Football – NFL Monday or
Thursday Night Games . . . . . . . . . .
Football – NFL Weekend Games . . . .
Football – NFL Playoffs/Super Bowl . . .
Golf – PGA . . . . . . . . . . . . . . . . . . . . .
Golf – LPGA . . . . . . . . . . . . . . . . . . . .
Golf – Other . . . . . . . . . . . . . . . . . . . .
Greyhound Racing . . . . . . . . . . . . . . .
Gymnastics . . . . . . . . . . . . . . . . . . . .
High School Sports . . . . . . . . . . . . . .
Horse Racing (at track or OTB) . . . . .
Ice Hockey – NHL Regular Season . .
Ice Hockey – NHL Playoffs and
Stanley Cup Finals . . . . . . . . . . . . .
Lacrosse – MLL . . . . . . . . . . . . . . . . .
Marathon/Road Running, Triathlon
& Other Endurance Events. . . . . . . .
Mixed Martial Arts (MMA). . . . . . . . . .
Motorcycle Racing . . . . . . . . . . . . . . .
Olympics – Summer . . . . . . . . . . . . . .
Olympics – Winter . . . . . . . . . . . . . . .
Poker Tournament . . . . . . . . . . . . . . .
Pro Bull Riding . . . . . . . . . . . . . . . . . .
Rodeo. . . . . . . . . . . . . . . . . . . . . . . . .
Soccer – MLS. . . . . . . . . . . . . . . . . . .
Soccer – World Cup . . . . . . . . . . . . . .
Tennis – Men’s . . . . . . . . . . . . . . . . . .
Tennis – Women’s. . . . . . . . . . . . . . . .
Track & Field. . . . . . . . . . . . . . . . . . . .
Truck and Tractor Pull/Mud Racing . . .
Volleyball – Pro Beach . . . . . . . . . . . .
Weightlifting . . . . . . . . . . . . . . . . . . . .
Wrestling – WWE . . . . . . . . . . . . . . . .
Wrestling – Other Professional . . . . . .
INTEREST
IN SPORTS
LISTENED TO RADIO
Regularly
Watched
Last 12
months
Regularly
Listened
Do you have a garden?
Regularly
Attended
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
1
2
3
4
5
6
On a scale from “0” to “10” where “0” means you are not a sports fan
at all, “5” means you are an average sports fan and “10” means you
are a super sports fan, where would you place yourself on that scale
for each of the following? (PLEASE “X” ONE BOX FOR EACH SPORT.)
What size is your garden?
Under 250 square feet. . . . . . . . . . . . . .
250-499 square feet . . . . . . . . . . . . . . .
500-1999 square feet . . . . . . . . . . . . . .
2000 or more square feet . . . . . . . . . . .
1
Average Fan
2
3
4
5
On how many days did you personally garden
in the past 12 months?
686-0
(Write in Number)
Which of the following did you engage in
during the last 12 months?
598-0
Flowers/Ornamentals . . . . . . . . . . . . . .
1
Vegetable Gardening. . . . . . . . . . . . . . .
2
Herb Growing . . . . . . . . . . . . . . . . . . . .
3
Fruit (Not Trees). . . . . . . . . . . . . . . . . . .
4
Lawn Care . . . . . . . . . . . . . . . . . . . . . . .
5
Berries & Brambles . . . . . . . . . . . . . . . .
6
7
8
9
Your Household:
Bought
last 12
months
PROPERTY
AND GARDEN
MAINTENANCE
687-0
Bulbs . . . . . . . . . . . . . . . . . . . . . . . .
Flower seeds . . . . . . . . . . . . . . . . . .
Garden fertilizer . . . . . . . . . . . . . . . .
Garden insecticides . . . . . . . . . . . . .
Garden soil . . . . . . . . . . . . . . . . . . . .
1
2
3
4
5
Lawn fertilizer with weed control . . .
Lawn fertilizer without weed control
Lawn insecticides . . . . . . . . . . . . . . .
Lawn maintenance service. . . . . . . .
Lawn seed . . . . . . . . . . . . . . . . . . . .
6
7
8
9
0
Organic soil additives . . . . . . . . . . . .
Plant food (outdoor) . . . . . . . . . . . . .
X
Y
Pool chemicals . . . . . . . . . . . . . . . . .
Potting soil . . . . . . . . . . . . . . . . . . . .
Shrubs & plants (outdoor) . . . . . . . .
Top soil . . . . . . . . . . . . . . . . . . . . . . .
Trees. . . . . . . . . . . . . . . . . . . . . . . . .
Vegetable plants. . . . . . . . . . . . . . . .
Vegetable seeds. . . . . . . . . . . . . . . .
Weed killer . . . . . . . . . . . . . . . . . . . .
588-0
1
2
3
4
5
6
7
8
Total amount spent on all garden items,
last 12 months
$
688-0
In the last 12 months have you used a
service, or services, for property and garden
maintenance?
Yes
1
689-0
No
PROFESSIONAL
EXTERMINATORS
Super-Fan
6
2
3
4
5
Did you participate in outdoor gardening in
the last 12 months?
Yes 6
No 7
491
0
1
Yes
ATTENDED
Last 12
months
Non-Fan
685-0
GARDEN
2
Your Household:
Had
treatment
Times/
last 12
last 12
months
months
10
College Basketball . . . . . . . College Football . . . . . . . . . Other College Sports . . . . . Golf. . . . . . . . . . . . . . . . . . . High School Sports. . . . . . . 01
02
03
04
05
Major League Baseball. . . . NASCAR. . . . . . . . . . . . . . . NBA . . . . . . . . . . . . . . . . . . NFL. . . . . . . . . . . . . . . . . . . NHL . . . . . . . . . . . . . . . . . . 06
07
08
09
10
Olympics. . . . . . . . . . . . . . . Professional Wrestling. . . . . Soccer . . . . . . . . . . . . . . . . Tennis . . . . . . . . . . . . . . . . . 11
12
13
14
690
TOTAL . . . . . . . . . . . . . . . . . .
FOR:
Insects (ants, roaches, etc.) .
Pests (mice, rats, etc.) . . . . .
Termites . . . . . . . . . . . . . . . .
COMPANIES:
Orkin . . . . . . . . . . . . . . . . . .
Terminix . . . . . . . . . . . . . . . .
OTHER (Write In)
00
01
02
03
04
05
999
YELLOW PAGES, OVERNIGHT DELIVERY, NEWSPAPERS,
BATTERIES, GAMES, BOOKS
YELLOW PAGES
691
Have you referred to the yellow pages when
considering the purchase or use of any product
or service?
You personally referred to:
Paper
yellow
pages
1
01
02
OVERNIGHT
PACKAGES/LETTER
DELIVERY SERVICES
Have you used an overnight package/letter
delivery service in the last 12 months?
Yes 1
No 2
660-0
661
Personal
01
02
03
04
05
2
Read in
Read in
Sunday/
Weekday
Weekend
Newspaper Newspaper
1
2
1
63Q
2
Main News/Front Page. . . . . .
International/National News . .
Local News . . . . . . . . . . . . . .
Business/Finance. . . . . . . . . .
Classified Advertising. . . . . . .
01
02
03
04
05
Comics . . . . . . . . . . . . . . . . . .
Editorial Page. . . . . . . . . . . . .
Entertainment/Lifestyle . . . . .
Fashion . . . . . . . . . . . . . . . . .
Food/Cooking. . . . . . . . . . . . .
06
07
08
09
10
Health. . . . . . . . . . . . . . . . . . .
Home/Home Design/
Furnishings/Gardening. . . . .
Movie Listings & Reviews . . .
Science & Technology . . . . . .
Sports . . . . . . . . . . . . . . . . . .
11
12
13
14
15
Travel . . . . . . . . . . . . . . . . . . .
TV Listings . . . . . . . . . . . . . . .
Weather . . . . . . . . . . . . . . . . .
Advertisements . . . . . . . . . . .
Circulars/Inserts/Fliers . . . . . .
16
17
18
19
20
Which of these actions did you take in the past
30 days, as a result of reading or looking into a
newspaper? (Check all that apply.)
650-0
Shopped at an advertised store. . . . . . . . . . .
Purchased an advertised product . . . . . . . . .
Requested additional information
on an advertised product . . . . . . . . . . . . . .
Cut out an ad for later reference . . . . . . . . . .
1
2
3
4
How useful do you find the advertising in your
newspaper? (Check one in each column.)
Sunday/
Weekday
Weekend
Newspaper Newspaper
Usefulness of Advertising:
Very . . . . . . . . . . . . . . . . . . . . . .
Somewhat . . . . . . . . . . . . . . . . .
Not at all . . . . . . . . . . . . . . . . . .
BATTERIES
5
6
7
8
9
0
You Personally:
Purchased
Number/
in last 6
last 6
months
months
633
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Rechargeable . . . . . . . . . . . .
Throw-away . . . . . . . . . . . . .
BRANDS:
Duracell . . . . . . . . . . . . . . . .
Duracell Quantum . . . . . . . .
Duracell Rechargeable . . . . .
Enercell . . . . . . . . . . . . . . . .
Energizer/Energizer Max . . .
Energizer Advanced Lithium
Energizer EcoAdvanced . . . .
Energizer Ultimate Lithium . .
Energizer Recharge . . . . . . .
Eveready Gold . . . . . . . . . . .
Eveready Super Heavy Duty .
Kodak . . . . . . . . . . . . . . . . . .
Panasonic. . . . . . . . . . . . . . .
Rayovac—Alkaline . . . . . . . .
Rayovac—Heavy Duty . . . . .
Sunbeam . . . . . . . . . . . . . . .
OTHER (Write In)
00
01
02
You Personally:
Bought
Number
last 12
bought last
months
12 months
693
Which of these sections do you read or look
at when you read your weekday and Sunday/
weekend newspaper?
Internet
yellow
pages
Last 12 months. . . . . . . . . . . Last 7 days . . . . . . . . . . . . . . Services Used:
Business
DHL . . . . . . . . . . . . . . . . . . . FedEx . . . . . . . . . . . . . . . . . . U.P.S. . . . . . . . . . . . . . . . . . . U.S. Postal Service. . . . . . . . Other . . . . . . . . . . . . . . . . . . CHILDREN’S
TOYS & GAMES
NEWSPAPER
READING
Page 58
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
999
Large/baby dolls . . . . . . . . .
Boy action figures. . . . . . . . .
Girl action figures . . . . . . . . .
Fashion dolls . . . . . . . . . . . .
Plush dolls/animals . . . . . . .
Electronic dolls/animals . . .
Doll clothing . . . . . . . . . . . . .
Doll accessories . . . . . . . . . .
Construction toys . . . . . . . . .
Educational toys . . . . . . . . . .
Mechanical toys . . . . . . . . . .
Model kits/Model sets . . . . .
Clay/dough/sand . . . . . . . . .
Arts & crafts . . . . . . . . . . . . .
Action games . . . . . . . . . . . .
Board games . . . . . . . . . . . .
Sound games . . . . . . . . . . . .
Word games . . . . . . . . . . . . .
Electronic games . . . . . . . . .
Infant toys . . . . . . . . . . . . . . .
Pre-school toys . . . . . . . . . . .
Builder sets . . . . . . . . . . . . .
Cars . . . . . . . . . . . . . . . . . . .
Electric trains . . . . . . . . . . . .
Bicycles . . . . . . . . . . . . . . . .
Tricycles . . . . . . . . . . . . . . . .
Water toys. . . . . . . . . . . . . . .
Other toys . . . . . . . . . . . . . . .
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
Amount spent for toys and games in last 12
months for children:
694
Under 1 year. . . . . . . . . . . . .
1-2 years old . . . . . . . . . . . . .
3-5 years old. . . . . . . . . . . . .
6-11 years old . . . . . . . . . . . .
12-17 years old. . . . . . . . . . .
BOOKS
$
$
$
$
$
01
02
03
04
05
You Personally:
Bought
Number
last 12
bought last
months
12 months
695
FORM:
Paperback . . . . . . . . . . . . . . Hardcover. . . . . . . . . . . . . . . Digital . . . . . . . . . . . . . . . . . . 01
02
03
KINDS:
Fiction. . . . . . . . . . . . . . . . . . Non-Fiction . . . . . . . . . . . . . . 04
05
TYPES:
Cookbooks. . . . . . . . . . . . . . .
Mystery. . . . . . . . . . . . . . . . .
Novel . . . . . . . . . . . . . . . . . .
Biography . . . . . . . . . . . . . . .
History . . . . . . . . . . . . . . . . .
Science fiction . . . . . . . . . . .
Children’s books . . . . . . . . . .
Romance . . . . . . . . . . . . . . .
Personal/business/self-help
Religious (not Bibles) . . . . . .
Travel . . . . . . . . . . . . . . . . . .
OTHER (Write In)
Where purchased:
Barnes & Noble Book store
Other book store . . . . . . . . .
amazon.com . . . . . . . . . . . .
barnes&noble.com . . . . . . .
Google Play. . . . . . . . . . . . .
iTunes/iBooks . . . . . . . . . . .
Other Internet/Online. . . . . .
Book club. . . . . . . . . . . . . . .
Department store. . . . . . . . .
Drug store . . . . . . . . . . . . . .
Mail order . . . . . . . . . . . . . .
Supermarket . . . . . . . . . . . .
Warehouse store . . . . . . . . .
696-0
1
2
3
4
5
6
7
60D-0
1
2
3
4
5
6
06
07
08
09
10
11
12
13
14
15
16
999
INTEREST IN ADVERTISING
Page 59
INTEREST IN
ADVERTISING
Please read the following statements and check the box that most closely reflects your opinion.
Questions are based on a 5 point scale.
697
Agree
Strongly
1
1
1
1
1
1
1
1. TV Advertising
1. Advertising on TV provides me with useful information about bargains.
2. Advertising on TV provides me with meaningful information about the
product use of other consumers.
3. Advertising on TV provides me with useful information about new products
and services.
4. For me, advertising on TV is amusing.
5. For me, advertising on TV appears at inconvenient moments.
6. For me, advertising on TV has no credibility.
7. For me, advertising on TV is repeated too often.
8. For me, all ads on TV are alike.
2. Radio Advertising
9. Advertising on radio provides me with useful information about bargains.
10. Advertising on radio provides me with meaningful information about the
11. Advertising on radio provides me with useful information about new products
and services.
12. For me, advertising on radio is amusing.
13. For me, advertising on radio appears at inconvenient moments.
14. For me, advertising on radio has no credibility.
15. For me, advertising on radio is repeated too often.
16. For me, all ads on radio are alike.
3. Newspaper Advertising
17. Advertising in newspapers provides me with useful information about bargains.
18. Advertising in newspapers provides me with meaningful information about the
19. Advertising in newspapers provides me with useful information about new
products and services.
20. For me, advertising in newspapers is amusing.
21. For me, advertising in newspapers appears at inconvenient moments.
22. For me, advertising in newspapers has no credibility.
23. For me, advertising in newspapers is repeated too often.
24. For me, all ads in newspapers are alike.
4. Magazine Advertising
25. Advertising in magazines provides me with useful information about bargains.
26. Advertising in magazines provides me with meaningful information about the
27. Advertising in magazines provides me with useful information about new
28. For me, advertising in magazines is amusing.
29. For me, advertising in magazines appears at inconvenient moments.
30. For me, advertising in magazines has no credibility.
31. For me, advertising in magazines is repeated too often.
32. For me, all ads in magazines are alike.
5. Internet Advertising
33. Advertising on the Internet provides me with useful information about bargains.
34. Advertising on the Internet provides me with meaningful information about the
35. Advertising on the Internet provides me with useful information about new
36. For me, advertising on the Internet is amusing.
37. For me, advertising on the Internet appears at inconvenient moments.
38. For me, advertising on the Internet has no credibility.
39. For me, advertising on the Internet is repeated too often.
40. For me, all ads on the Internet are alike.
1
1
1
1
1
1
1
6. Mobile Advertising
41. Advertising on mobile phones provides me with useful information about bargains.
42. Advertising on mobile phones provides me with meaningful information about the
43. Advertising on mobile phones provides me with useful information about new
44. For me, advertising on mobile phones is amusing.
45. For me, advertising on mobile phones appears at inconvenient moments.
46. For me, advertising on mobile phones has no credibility.
47. For me, advertising on mobile phones is repeated too often.
48. For me, all ads on mobile phones are alike.
Agree
Somewhat
Neutral
Disagree
Somewhat
Disagree
Strongly
1
2
3
4
5
GENERAL ATTITUDES
Page 60
We are interested in your attitudes about a number of buying and style issues. There are no right or wrong answers. Please indicate how much you
AGREE or DISAGREE with each of the following statements by checking the box that comes closest to how you feel.
(FOR EACH QUESTION, PLEASE SELECT ONE ANSWER FOR EACH ITEM AND CHECK ONLY ONE BOX ON EACH LINE BELOW.)
DISAGREE
698
01. Buying American products is important to me. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
02. I know the price I pay for most of the foods and packaged goods I buy.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
03. I think shopping is a great way to relax. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4. I enjoy wandering the store looking for new, interesting products. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5. I only purchase products online when I have a coupon or promotional code for the site . . . . . . . . . . . . . . . . . .
06. I don’t make purchase decisions based on advertising. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
07. I like to shop around before making a purchase.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
08. If I really want something I will buy it on credit rather than wait. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
09. I buy based on quality, not price. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10. I buy natural products because I am concerned about the environment.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11. The offer of “free shipping” attracts me to a shopping website . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12. Price is more important to me than brand names. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13. I’m a “spender” rather than a “saver”. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14. It’s important to me that salespeople be knowledgeable about the products they sell. . . . . . . . . . . . . . . . . . . . .
15. I am influenced by what’s hot and what’s not.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16. How a personal care or household product smells is very important to me.. . . . . . . . . . . . . . . . . . . . . . . . . . . .
17. I like to share my opinions about products and services by posting reviews and ratings online. .. . . . . . . . . . . .
18. My favorite grocery store offers low prices on all products every day.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
19. A celebrity endorsement may influence me to consider or buy a product. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
20. I only use coupons for those brands I usually buy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
21. I am annoyed by all of the signs in the stores.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
22. I expect the brands I buy to support social causes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
23. I often seek the advice of others before making a purchase. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
24. Before purchasing a product online, I typically read online reviews submitted by others . . . . . . . . . . . . . . . . . .
25. I am willing to give up convenience in return for a product that is environmentally safe. . . . . . . . . . . . . . . . . . .
26. Shopping used to be more enjoyable.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
27. I buy brands that reflect my style. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
28. People often come to me for advice before making a purchase. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
29. I tend to make impulse purchases.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
30. I buy the brands I grew up with, the ones my parents used.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
31. I prefer products that offer the latest in new technology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
32. My number one goal when shopping is to save as much money as possible. . . . . . . . . . . . . . . . . . . . . . . . . . .
33. I always check the ingredients and nutritional content of food products before I buy them. . . . . . . . . . . . . . . . .
34. I often save money by buying previously used items online . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
35. I don’t have time to bother clipping or saving coupons. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
36. My children have a significant impact on the brands I choose. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
37. I smell personal care and household products in the store before I buy them. . . . . . . . . . . . . . . . . . . . . . . . . . .
38. I would pay extra for a product that is consistent with the image I want to convey.. . . . . . . . . . . . . . . . . . . . . . .
39. My spouse has a significant impact on the brands I choose. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
40. I like to compare prices across different sites before purchasing something online. .. . . . . . . . . . . . . . . . . . . . .
41. When I find a brand I like, I stick to it. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
42. If a product is made by a company I trust, I’ll buy it even if it is slightly more expensive. . . . . . . . . . . . . . . . . . .
43. I like to change brands often for the sake of variety and novelty. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
44. I buy natural products because I am concerned about me and my family’s health. . . . . . . . . . . . . . . . . . . . . . .
45. I think if a manufacturer offers a coupon, I am probably being overcharged to begin with.. . . . . . . . . . . . . . . . .
46. I prefer purchasing things online for a fixed price, as opposed to bidding in online auctions . . . . . . . . . . . . . . .
47. The service of the personnel at a store is an important part of my decision to shop there.. . . . . . . . . . . . . . . . .
48. I will gladly switch brands to use a coupon. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
49. I am more likely to purchase brands that support a cause I care about. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
50. I’m always one of the first of my friends to try new products or services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
51. I prefer a store that has a large selection of familiar brands.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
52. I usually like to wait until other people have tried things before I try them myself. . . . . . . . . . . . . . . . . . . . . . . .
53. Generic or store brand products are as effective as brand-name products. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
54 I use the Internet to buy hard-to-find products. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
55. I’d rather receive a sample of a product than a coupon.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
56. I am willing to pay more for a product that is environmentally safe. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
57. I prefer to shop at stores that specialize in a specific type or style of product. . . . . . . . . . . . . . . . . . . . . . . . . . .
58. Brand name is the best indication of quality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
59. I prefer to buy things my friends or neighbors would approve of. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
60. I like to connect with brands through social-networking sites. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
61. I prefer to shop at stores that offer loyalty points. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mostly
Somewhat
1
2
AGREE
Somewhat
3
Mostly
4
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
TELEVISION VIEWING
Page 61
TELEVISION
VIEWING
Listed below are television programs that are shown Monday through Friday. Please check in the appropriate columns below.
1. How many times a week do you usually
2. Did you watch
3. If you watched the
4. If you watched
watch the following programs?
the program
program yesterday,
the program
yesterday (if
how much attention
yesterday,
today is Sunday
were you paying?
where did you
or Monday, did
watch it?
you watch
the program
on Friday)?
None
1
2
3
4
5
Yes
Full
Most
Some
Your
Own
Home
X
1
2
3
4
5
6
8
9
0
5
4
68A
EARLY MORNING NEWS
01 ABC America This Morning. . . . . .
02 CBS Morning News . . . . . . . . . . .
03 Early Today . . . . . . . . . . . . . . . . . .
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EARLY MORNING WEEKDAY NEWS PROGRAMS (LOCAL)
ABC (local TV news) . . . . . . . . . . .
CBS (local TV news) . . . . . . . . . .
FOX (local TV news) . . . . . . . . . . .
NBC (local TV news). . . . . . . . . . .
EARLY MORNING PROGRAMS
CBS This Morning (Charlie Rose/
Gayle King/Norah O’Donnell) . .
Good Morning America
(Stephanopoulos/Roberts) . . . .
Today Show (Lauer/Guthrie) . . . . .
Today II - 3rd Hour
(Roker/Morales/Geist/Hall) . . . .
Today III - 4th Hour
(Hoda Kotb/Kathie Lee Gifford) .
Somewhere
Else
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68E
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DAYTIME
The Bold & The Beautiful . . . . . . .
The Chew . . . . . . . . . . . . . . . . . . .
Days of Our Lives . . . . . . . . . . . . .
The Fab Life . . . . . . . . . . . . . . . . .
General Hospital . . . . . . . . . . . . . .
Let’s Make a Deal . . . . . . . . . . . . .
The Price is Right . . . . . . . . . . . . .
The Talk . . . . . . . . . . . . . . . . . . . .
The View with Whoopi Goldberg . .
The Young & The Restless . . . . . .
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EARLY EVENING WEEKDAY NEWS PROGRAMS
ABC World News with David Muir .
BBC World News . . . . . . . . . . . . .
CBS Evening News (Scott Pelley) .
NBC Nightly News with Lester Holt .
Nightly Business Report . . . . . . . .
PBS NewsHour . . . . . . . . . . . . . . .
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EARLY EVENING WEEKDAY NEWS PROGRAMS (LOCAL)
ABC (local TV news) . . . . . . . . . . .
CBS (local TV news) . . . . . . . . . .
FOX (local TV news) . . . . . . . . . . .
NBC (local TV news). . . . . . . . . . .
X
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LATE EVENING WEEKDAY NEWS PROGRAMS (LOCAL)
ABC (local TV news) . . . . . . . . . . .
CBS (local TV news) . . . . . . . . . .
FOX (local TV news) . . . . . . . . . . .
NBC (local TV news). . . . . . . . . . .
LATE NIGHT SHOWS (Nightly)
ABC News: Nightline. . . . . . . . . . .
ABC World News Now . . . . . . . . .
All Night–Dateline . . . . . . . . . . . . .
All Night–Mad Money . . . . . . . . . .
All Night–Tonight Show . . . . . . . . .
All Night–any other All Night
programs . . . . . . . . . . . . . . . . . .
CBS Overnight News . . . . . . . . . .
Charlie Rose . . . . . . . . . . . . . . . . .
Jimmy Kimmel Live . . . . . . . . . . . .
Last Call with Carson Daly . . . . . .
Late Late Show with James
Corden . . . . . . . . . . . . . . . . . . .
Late Night with Seth Meyers . . . . .
Late Show with Stephen Colbert .
Tavis Smiley . . . . . . . . . . . . . . . . .
The Tonight Show Starring
Jimmy Fallon . . . . . . . . . . . . . . .
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TELEVISION VIEWING
TELEVISION
VIEWING
(Continued)
Page 62
1. How many times a month do
you usually watch the following
programs?
2. Did you watch
the program
in the past
7 days?
68F
program in the
past 7 days, how
much attention
were you paying?
ONCE A WEEK PROGRAMS
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ABC Saturday Movie of the Week .
After Paradise . . . . . . . . . . . . . . . .
The Amazing Race . . . . . . . . . . . .
American Crime . . . . . . . . . . . . . .
American Experience . . . . . . . . .
American Grit . . . . . . . . . . . . . . . .
American Idol . . . . . . . . . . . . . . . .
American Idol Rewind . . . . . . . . .
American Ninja Warrior . . . . . . . .
America’s Funniest Home Videos .
America’s Got Talent . . . . . . . . . . .
America’s Test Kitchen . . . . . . . . .
Angel From Hell . . . . . . . . . . . . . .
Animal Atlas . . . . . . . . . . . . . . . . .
Antiques Roadshow . . . . . . . . . . .
Aquarius . . . . . . . . . . . . . . . . . . . .
Arrow . . . . . . . . . . . . . . . . . . . . . .
Austin City Limits . . . . . . . . . . . . .
The Bachelor . . . . . . . . . . . . . . . .
Battlebots . . . . . . . . . . . . . . . . . . .
Beauty and the Beast . . . . . . . . . .
Best Time Ever . . . . . . . . . . . . . . .
Better Late Than Never . . . . . . . . .
Beyond the Tank . . . . . . . . . . . . . .
The Big Bang Theory . . . . . . . . . .
The Big Bang Theory - Weekend .
The Biggest Loser. . . . . . . . . . . . .
Black-ish . . . . . . . . . . . . . . . . . . . .
The Blacklist . . . . . . . . . . . . . . . . .
Blindspot . . . . . . . . . . . . . . . . . . . .
Blue Bloods. . . . . . . . . . . . . . . . . .
Blue Bloods - Weekend . . . . . . . .
Bob’s Burgers . . . . . . . . . . . . . . . .
Bob's Burgers - Weekend . . . . . . .
Bones . . . . . . . . . . . . . . . . . . . . . .
Bones - Weekend . . . . . . . . . . . . .
Bordertown . . . . . . . . . . . . . . . . . .
Born to Explore . . . . . . . . . . . . . . .
Brooklyn Nine-Nine . . . . . . . . . . . .
Calling Dr. Pol . . . . . . . . . . . . . . . .
Castle . . . . . . . . . . . . . . . . . . . . . .
Castle - Weekend . . . . . . . . . . . . .
The Catch . . . . . . . . . . . . . . . . . . .
Caught on Camera . . . . . . . . . . . .
Celebrity Apprentice . . . . . . . . . . .
Celebrity Family Feud . . . . . . . . . .
Celebrity Wife Swap . . . . . . . . . . .
Chicago Fire . . . . . . . . . . . . . . . . .
Chicago Med. . . . . . . . . . . . . . . . .
Chicago PD. . . . . . . . . . . . . . . . . .
The Closer - Weekend . . . . . . . . .
Code Black . . . . . . . . . . . . . . . . . .
Community - Weekend . . . . . . . . .
Containment . . . . . . . . . . . . . . . . .
Cooper Barrett’s Guide to
Surviving Life. . . . . . . . . . . . . . .
Crimetime Saturday . . . . . . . . . . .
Crazy Ex-Girlfriend . . . . . . . . . . . .
Criminal Minds . . . . . . . . . . . . . . .
Criminal Minds: Beyond Borders. .
Crowded . . . . . . . . . . . . . . . . . . . .
CSI: Cyber . . . . . . . . . . . . . . . . . .
Da Vinci’s Inquest . . . . . . . . . . . . .
Dancing With The Stars . . . . . . . .
Dateline . . . . . . . . . . . . . . . . . . . . .
Dog Whisperer: Family Edition . . .
Dog Town, USA . . . . . . . . . . . . . . .
Dr. Chris Pet Vet . . . . . . . . . . . . . .
Dr. Ken . . . . . . . . . . . . . . . . . . . . .
Dream Quest . . . . . . . . . . . . . . . .
Elementary . . . . . . . . . . . . . . . . . .
Elementary - Weekend . . . . . . . . .
Emerald City . . . . . . . . . . . . . . . . .
Empire . . . . . . . . . . . . . . . . . . . . .
Entertainment Tonight - Weekend .
Extra: Weekend . . . . . . . . . . . . . . .
Extreme Makeover: Weight Loss
Edition . . . . . . . . . . . . . . . . . . . .
The Family . . . . . . . . . . . . . . . . . .
Family Feud - Weekend . . . . . . . .
Family Guy . . . . . . . . . . . . . . . . . .
Finding your Roots with Skip Gates
4. If you watched
the program in
the past 7 days,
where did you
watch it?
None
1
2
3
4
Yes
Full
Most
Some
Your
Own
Home
Somewhere
Else
X
1
2
3
4
6
8
9
0
5
4
TELEVISION VIEWING
Page 63
TELEVISION
VIEWING
(Continued)
programs?
2. Did you watch
the program
in the past
7 days?
68F
program in the
past 7 days, how
much attention
were you paying?
ONCE A WEEK PROGRAMS (Continued)
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First Dates . . . . . . . . . . . . . . . . . . .
The Flash . . . . . . . . . . . . . . . . . . .
Forever . . . . . . . . . . . . . . . . . . . . .
48 Hours . . . . . . . . . . . . . . . . . . . .
Fresh Off the Boat . . . . . . . . . . . . .
Friends - Weekend . . . . . . . . . . . .
Frontline . . . . . . . . . . . . . . . . . . . .
Futurama - Weekend. . . . . . . . . . .
Galavant . . . . . . . . . . . . . . . . . . . .
Game Changers with
Kevin Frazier . . . . . . . . . . . . . . .
Game of Silence . . . . . . . . . . . . . .
Globe Trekker . . . . . . . . . . . . . . . .
The Goldbergs . . . . . . . . . . . . . . .
The Good Wife . . . . . . . . . . . . . . .
The Good Wife - Weekend . . . . . .
GOTHAM . . . . . . . . . . . . . . . . . . .
Grey’s Anatomy . . . . . . . . . . . . . . .
Grandfathered . . . . . . . . . . . . . . . .
Grimm . . . . . . . . . . . . . . . . . . . . . .
The Grinder. . . . . . . . . . . . . . . . . .
Hatched . . . . . . . . . . . . . . . . . . . .
Hawaii Five-O . . . . . . . . . . . . . . . .
Heartbeat . . . . . . . . . . . . . . . . . . .
Hell’s Kitchen . . . . . . . . . . . . . . . .
Hidden Heroes . . . . . . . . . . . . . . .
Hollywood Game Night . . . . . . . . .
Home Free . . . . . . . . . . . . . . . . . .
Houdini & Doyle. . . . . . . . . . . . . . .
How to Get Away with Murder . . . .
In an Instant . . . . . . . . . . . . . . . . .
Innovation Nation . . . . . . . . . . . . .
Inside Edition - Weekend . . . . . . .
Insider Weekend . . . . . . . . . . . . . .
The Inspectors . . . . . . . . . . . . . . .
iZombie . . . . . . . . . . . . . . . . . . . . .
Jack Hanna’s Wild Countdown . . .
Jane the Virgin . . . . . . . . . . . . . . .
Jeopardy - Weekend . . . . . . . . . . .
Just for Laughs . . . . . . . . . . . . . .
King of Queens - Weekend . . . . . .
Last Comic Standing . . . . . . . . . . .
The Last Man on Earth . . . . . . . . .
Last Man Standing . . . . . . . . . . . .
Law & Order: Special Victims Unit . .
Legends of Tomorrow . . . . . . . . . .
Lidia’s Italy in America . . . . . . . . .
Life in Pieces . . . . . . . . . . . . . . . .
Limitless . . . . . . . . . . . . . . . . . . . .
Little Big Shots . . . . . . . . . . . . . . .
Lucifer . . . . . . . . . . . . . . . . . . . . . .
Lucky Dog . . . . . . . . . . . . . . . . . . .
Madam Secretary . . . . . . . . . . . . .
Marvel’s Agent Carter . . . . . . . . . .
Marvel’s Agents of S.H.I.E.L.D. . . .
MasterChef . . . . . . . . . . . . . . . . . .
MasterChef Jr. . . . . . . . . . . . . . . .
Masterpiece . . . . . . . . . . . . . . . . .
Maya & Marty . . . . . . . . . . . . . . . .
The Mentalist . . . . . . . . . . . . . . . .
The Middle . . . . . . . . . . . . . . . . . .
The Middle - Weekend . . . . . . . . .
Mike & Molly . . . . . . . . . . . . . . . . .
Mike & Molly - Weekend . . . . . . . .
Mistresses. . . . . . . . . . . . . . . . . . .
Modern Family . . . . . . . . . . . . . . .
Mom . . . . . . . . . . . . . . . . . . . . . . .
Motor Week . . . . . . . . . . . . . . . . . .
The Muppets . . . . . . . . . . . . . . . . .
My Diet is Better Than Yours . . . . .
The Mysteries of Laura . . . . . . . . .
Nashville . . . . . . . . . . . . . . . . . . . .
Nature . . . . . . . . . . . . . . . . . . . . . .
NCIS . . . . . . . . . . . . . . . . . . . . . . .
NCIS: Los Angeles . . . . . . . . . . . .
NCIS: New Orleans. . . . . . . . . . . .
New Girl . . . . . . . . . . . . . . . . . . . .
The Night Shift . . . . . . . . . . . . . . .
NOVA . . . . . . . . . . . . . . . . . . . . . .
NY Med . . . . . . . . . . . . . . . . . . . . .
Ocean Mysteries . . . . . . . . . . . . . .
4. If you watched
the program in
the past 7 days,
where did you
watch it?
None
1
2
3
4
Yes
Full
Most
Some
Your
Own
Home
Somewhere
Else
X
1
2
3
4
6
8
9
0
5
4
TELEVISION VIEWING
TELEVISION
VIEWING
(Continued)
Page 64
programs?
2. Did you watch
the program
in the past
7 days?
68F
program in the
past 7 days, how
much attention
were you paying?
ONCE A WEEK PROGRAMS (Continued)
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The Odd Couple . . . . . . . . . . . . . .
Of Kings & Prophets . . . . . . . . . . .
Once Upon a Time . . . . . . . . . . . .
The 100 . . . . . . . . . . . . . . . . . . . . .
The Originals . . . . . . . . . . . . . . . .
Outer Limits . . . . . . . . . . . . . . . . .
Penn and Teller: Fool Us . . . . . . . .
The Player. . . . . . . . . . . . . . . . . . .
Person of Interest . . . . . . . . . . . . .
Person of Interest - Weekend . . . .
Primetime: What Would You Do?. .
Q. . . . . . . . . . . . . . . . . . . . . . . . . .
Quantico . . . . . . . . . . . . . . . . . . . .
The Real O'Neals . . . . . . . . . . . . .
Reign . . . . . . . . . . . . . . . . . . . . . .
Religion & Ethics Newsweekly . . .
Revenge . . . . . . . . . . . . . . . . . . . .
Rick Steves’ Europe . . . . . . . . . . .
Rizzoli & Isles - Weekend . . . . . . .
Rock the Park . . . . . . . . . . . . . . . .
Rookie Blue - Weekend . . . . . . . .
Rosewood . . . . . . . . . . . . . . . . . . .
Rules of Engagement - Weekend .
Rush Hour. . . . . . . . . . . . . . . . . . .
Safari Tracks . . . . . . . . . . . . . . . . .
Sanctuary . . . . . . . . . . . . . . . . . . .
Save Our Shelter . . . . . . . . . . . . .
Scandal . . . . . . . . . . . . . . . . . . . . .
Scandal - Weekend . . . . . . . . . . . .
Scorpion . . . . . . . . . . . . . . . . . . . .
Scream Queens . . . . . . . . . . . . . .
Sea Rescue . . . . . . . . . . . . . . . . .
Second Chance . . . . . . . . . . . . . .
Secrets and Lies . . . . . . . . . . . . . .
Seinfeld - Weekend . . . . . . . . . . . .
Shades of Blue . . . . . . . . . . . . . . .
Shark Tank . . . . . . . . . . . . . . . . . .
Significant Mother . . . . . . . . . . . . .
Simply Ming . . . . . . . . . . . . . . . . .
The Simpsons . . . . . . . . . . . . . . . .
60 Minutes . . . . . . . . . . . . . . . . . .
Sleepy Hollow . . . . . . . . . . . . . . . .
So You Think You Can Dance . . . .
Son Of Zorn . . . . . . . . . . . . . . . . .
Soundstage. . . . . . . . . . . . . . . . . .
Spartan Race . . . . . . . . . . . . . . . .
Stargate: Atlantis . . . . . . . . . . . . . .
Stargate: SG1 . . . . . . . . . . . . . . . .
Storm Stories . . . . . . . . . . . . . . . .
Strong . . . . . . . . . . . . . . . . . . . . . .
Supergirl . . . . . . . . . . . . . . . . . . . .
Supernatural . . . . . . . . . . . . . . . . .
Superstore . . . . . . . . . . . . . . . . . .
Survivor. . . . . . . . . . . . . . . . . . . . .
Telenovela . . . . . . . . . . . . . . . . . . .
Tell the Truth . . . . . . . . . . . . . . . . .
This Old House . . . . . . . . . . . . . . .
TMZ - Weekend . . . . . . . . . . . . . .
Tosh.0 - Weekend . . . . . . . . . . . . .
Truth Be Told . . . . . . . . . . . . . . . . .
20/20 . . . . . . . . . . . . . . . . . . . . . . .
Two and a Half Men - Weekend . .
2 Broke Girls . . . . . . . . . . . . . . . . .
2 Broke Girls - Weekend . . . . . . . .
Uncle Buck . . . . . . . . . . . . . . . . . .
Undateable . . . . . . . . . . . . . . . . . .
Undercover Boss . . . . . . . . . . . . .
The Vampire Diaries . . . . . . . . . . .
Victory Garden . . . . . . . . . . . . . . .
The Voice . . . . . . . . . . . . . . . . . . .
The Walking Dead . . . . . . . . . . . .
Washington Week . . . . . . . . . . . . .
Wayward Pines . . . . . . . . . . . . . . .
Wheel of Fortune - Weekend . . . .
White Collar . . . . . . . . . . . . . . . . .
Whose Line is it Anyway? . . . . . . .
Wicked Offer . . . . . . . . . . . . . . . . .
Wife Swap . . . . . . . . . . . . . . . . . . .
The Wild Life of Tim Faulkner . . . .
The Wildlife Docs . . . . . . . . . . . . .
World's Funniest Fails . . . . . . . . . .
The X-Files . . . . . . . . . . . . . . . . . .
You, Me and the Apocalypse. . . . .
You The Jury . . . . . . . . . . . . . . . . .
You're Back In The Room . . . . . . .
4. If you watched
the program in
the past 7 days,
where did you
watch it?
None
1
2
3
4
Yes
Full
Most
Some
Your
Own
Home
Somewhere
Else
X
1
2
3
4
6
8
9
0
5
4
TELEVISION VIEWING
Page 65
TELEVISION
VIEWING
(Continued)
1. How many times a week do you usually
watch the following programs?
2. Did you watch
the program
yesterday (if
today is Sunday
or Monday, did
you watch
the program
on Friday)?
68L
program yesterday,
how much attention
were you paying?
MONDAY THROUGH FRIDAY PROGRAMS
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Access Hollywood . . . . . . . . . . . . .
Access Hollywood Live . . . . . . . . .
American Dad . . . . . . . . . . . . . . . .
Anger Management . . . . . . . . . . .
Are We There Yet? . . . . . . . . . . . .
The Big Bang Theory . . . . . . . . . .
Cash Cab . . . . . . . . . . . . . . . . . . .
Celebrity Name Game . . . . . . . . .
The Cleveland Show . . . . . . . . . . .
Community . . . . . . . . . . . . . . . . . .
Cops . . . . . . . . . . . . . . . . . . . . . . .
Cops Reloaded . . . . . . . . . . . . . . .
Cougar Town . . . . . . . . . . . . . . . . .
Crazy Talk . . . . . . . . . . . . . . . . . . .
Crime Watch Daily . . . . . . . . . . . .
Dish Nation . . . . . . . . . . . . . . . . . .
Divorce Court . . . . . . . . . . . . . . . .
The Doctors . . . . . . . . . . . . . . . . .
The Dr. Oz Show. . . . . . . . . . . . . .
The Dr. Phil Show . . . . . . . . . . . . .
Ellen Degeneres . . . . . . . . . . . . . .
Entertainment Tonight . . . . . . . . . .
Everybody Loves Raymond . . . . .
Extra . . . . . . . . . . . . . . . . . . . . . . .
FABLife . . . . . . . . . . . . . . . . . . . . .
Family Feud (Steve Harvey) . . . . .
Family Guy . . . . . . . . . . . . . . . . . .
Friends . . . . . . . . . . . . . . . . . . . . .
Golf Magazine TV . . . . . . . . . . . . .
Harry Connick Jr. Show . . . . . . . .
Hot Bench . . . . . . . . . . . . . . . . . . .
Hot in Cleveland . . . . . . . . . . . . . .
How I Met Your Mother . . . . . . . . .
Inside Edition . . . . . . . . . . . . . . . .
Insider . . . . . . . . . . . . . . . . . . . . . .
Jeopardy! . . . . . . . . . . . . . . . . . . .
The Jerry Springer Show . . . . . . .
Judge Judy . . . . . . . . . . . . . . . . . .
Judge Mathis . . . . . . . . . . . . . . . .
King of Queens . . . . . . . . . . . . . . .
King of the Hill. . . . . . . . . . . . . . . .
Law & Order: Criminal Intent . . . .
Law & Order: Special Victims Unit
Live with Kelly & Michael . . . . . . .
MASH . . . . . . . . . . . . . . . . . . . . . .
Maury . . . . . . . . . . . . . . . . . . . . . .
The Meredith Vieira Show . . . . . . .
The Middle . . . . . . . . . . . . . . . . . .
Mike & Molly . . . . . . . . . . . . . . . . .
Modern Family . . . . . . . . . . . . . . .
The Office . . . . . . . . . . . . . . . . . . .
People’s Court. . . . . . . . . . . . . . . .
Rachael Ray . . . . . . . . . . . . . . . . .
Raising Hope . . . . . . . . . . . . . . . .
The Real . . . . . . . . . . . . . . . . . . . .
Right This Minute . . . . . . . . . . . . .
Rules of Engagement . . . . . . . . . .
Seinfeld . . . . . . . . . . . . . . . . . . . . .
The 700 Club . . . . . . . . . . . . . . . .
The Simpsons . . . . . . . . . . . . . . . .
Steve Harvey Show. . . . . . . . . . . .
The Steve Wilkos Show . . . . . . . .
TMZ . . . . . . . . . . . . . . . . . . . . . . .
Two and a Half Men . . . . . . . . . . .
2 Broke Girls . . . . . . . . . . . . . . . . .
The Wendy Williams Show . . . . . .
Wheel of Fortune . . . . . . . . . . . . .
Who Wants To Be A Millionaire . . .
4. If you watched
the program
yesterday,
where did you
watch it?
None
1
2
3
4
5
Yes
Full
Most
Some
Your
Own
Home
Somewhere
Else
X
1
2
3
4
5
6
8
9
0
5
4
TELEVISION VIEWING/CABLE/SATELLITE/STREAMING TV NETWORKS
Listed below are television programs that are shown once a week. Please check in the appropriate columns below.
TELEVISION
VIEWING
(Continued)
programs?
2. Did you watch
the program
in the past
7 days?
program in the
past 7 days, how
much attention
were you paying?
4. If you watched
the program in
the past 7 days,
where did you
watch it?
2
3
4
Yes
Full
Most
Some
Your
Own
Home
2
3
4
6
8
9
0
5
4
68H
None
01
02
03
04
05
06
08
09
10
11
12
13
14
15
16
1
EARLY EVENING WEEKEND NEWS PROGRAMS
ABC World News Tonight-Sat . . . .
ABC World News Tonight-Sun. . . .
CBS Evening News-Sat . . . . . . . .
CBS Evening News-Sun. . . . . . . .
NBC Nightly News-Sat . . . . . . . . .
NBC Nightly News-Sun. . . . . . . . .
X
07
Page 66
1
WEEKEND NEWS/INFORMATION PROGRAMS
ABC This Week with George
Stephanopoulos . . . . . . . . . . . .
CBS Face the Nation . . . . . . . . . .
CBS Sunday Morning . . . . . . . . . .
CBS This Morning: Saturday . . . . .
FOX News Sunday . . . . . . . . . . . .
Good Morning America Weekend
Edition . . . . . . . . . . . . . . . . . . . .
NBC Meet the Press . . . . . . . . . . .
NBC Saturday Today . . . . . . . . . . .
NBC Sunday Today . . . . . . . . . . . .
Wall Street Journal Report . . . . . .
LATE NIGHT PROGRAMS
17 Saturday Night Live . . . . . . . . . . . .
CABLE/SATELLITE/
STREAMING TV
NETWORKS
66X
01
02
03
04
05
06
A&E
Bates Motel . . . . . . . . . . . . . . . . . .
Duck Dynasty . . . . . . . . . . . . . . . . .
The First 48 . . . . . . . . . . . . . . . . . .
Storage Wars . . . . . . . . . . . . . . . . .
Unforgettable . . . . . . . . . . . . . . . . .
Wahlburgers . . . . . . . . . . . . . . . . . .
07
08
09
10
11
Adult Swim
American Dad . . . . . . . . . . . . . . . .
Family Guy . . . . . . . . . . . . . . . . . . .
Mike Tyson Mysteries . . . . . . . . . . .
Rick & Morty. . . . . . . . . . . . . . . . . .
Robot Chicken. . . . . . . . . . . . . . . . .
Somewhere
Else
X
1
2
3
4
6
8
9
0
5
4
X
1
2
3
4
6
8
9
0
5
4
Watched Watched
last
last
30 days 7 days
If you watched the
program in the Past 7
days, how much
attention were
you paying?
Full Most Some
CABLE/SATELLITE/
STREAMING TV
NETWORKS
(Continued)
66X
Watched Watched
last
last
30 days 7 days
Bravo
27 Million Dollar Listing NY . . . . . . . . .
28 Odd Mom Out. . . . . . . . . . . . . . . . .
29 The Real Housewives
of New York City . . . . . . . . . . . . .
30 The Real Housewives
of Orange County . . . . . . . . . . . .
31 Watch What Happens Live . . . . . . .
If you watched the
days, how much
attention were
you paying?
Full Most Some
Cartoon Network
12
13
14
15
16
Amazon Prime Instant Video
Bosch . . . . . . . . . . . . . . . . . . . . . . .
The Man in the High Castle . . . . . .
Mozart in the Jungle. . . . . . . . . . . .
Red Oaks . . . . . . . . . . . . . . . . . . . .
Transparent. . . . . . . . . . . . . . . . . . .
17
18
19
20
21
AMC
Broke . . . . . . . . . . . . . . . . . . . . . . .
Fear the Walking Dead. . . . . . . . . .
Preacher. . . . . . . . . . . . . . . . . . . . .
Talking Dead . . . . . . . . . . . . . . . . .
Turn: Washington Spies . . . . . . . . .
22
23
24
25
26
Animal Planet
Finding Bigfoot . . . . . . . . . . . . . . . .
My Cat From Hell. . . . . . . . . . . . . . .
Pit Bulls & Parolees . . . . . . . . . . . . .
River Monsters. . . . . . . . . . . . . . . . .
Tanked . . . . . . . . . . . . . . . . . . . . . .
1
6
8
9
0
32
33
34
35
36
Adventure Time . . . . . . . . . . . . . . .
Powerpuff Girls . . . . . . . . . . . . . . .
Teen Titans Go! . . . . . . . . . . . . . . .
Wabbit . . . . . . . . . . . . . . . . . . . . . .
We Bare Bears . . . . . . . . . . . . . . . .
37
38
39
40
41
CNBC
Fast Money. . . . . . . . . . . . . . . . . . .
Mad Money . . . . . . . . . . . . . . . . . .
The Profit . . . . . . . . . . . . . . . . . . . .
Shark Tank . . . . . . . . . . . . . . . . . . .
Squawk Box . . . . . . . . . . . . . . . . .
42
43
44
45
46
CNN
Anderson Cooper 360°. . . . . . . . . .
Anthony Bourdain “Parts Unknown”
CNN Films . . . . . . . . . . . . . . . . . . .
Inside Man . . . . . . . . . . . . . . . . . . .
New Day. . . . . . . . . . . . . . . . . . . . .
1
6
8
9
0
CABLE/SATELLITE/STREAMING TV NETWORKS
Page 67
CABLE/SATELLITE/
STREAMING TV
NETWORKS
(Continued)
66X
Watched Watched
last
last
30 days 7 days
If you watched the
days, how much
attention were
you paying?
Full Most Some
CABLE/SATELLITE/
STREAMING TV
NETWORKS
(Continued)
66X
$PNFEZ$FOUSBM
47
48
49
50
51
@Midnight with Chris Hardwick . . .
Broad City . . . . . . . . . . . . . . . . . . .
The Daily Show with Trevor Noah. .
Drunk History . . . . . . . . . . . . . . . . .
The Nightly Show with Larry Wilmore
52
53
54
55
56
Discovery Channel
Alaskan Bush People . . . . . . . . . . .
Deadliest Catch . . . . . . . . . . . . . . .
Fast N’ Loud . . . . . . . . . . . . . . . . .
Naked & Afraid . . . . . . . . . . . . . . . .
Street Outlaws . . . . . . . . . . . . . . . .
57
58
59
60
61
62
E! (Entertainment Television)
E! News . . . . . . . . . . . . . . . . . . . . .
Fashion Police . . . . . . . . . . . . . . . .
I Am Cait. . . . . . . . . . . . . . . . . . . . .
Keeping up with the Kardashians. .
The Royals . . . . . . . . . . . . . . . . . . .
Total Divas . . . . . . . . . . . . . . . . . . .
63
64
65
66
67
ESPN
Around the Horn. . . . . . . . . . . . . . .
College Football Live . . . . . . . . . . .
NFL Live. . . . . . . . . . . . . . . . . . . . .
PTI (Pardon the Interruption) . . . . .
SportsCenter . . . . . . . . . . . . . . . . .
68
69
70
71
72
ESPN2
First Take . . . . . . . . . . . . . . . . . . . .
His & Hers . . . . . . . . . . . . . . . . . . .
Mike & Mike in the Morning . . . . . .
Olbermann . . . . . . . . . . . . . . . . . . .
SportsNation . . . . . . . . . . . . . . . . .
73
74
75
76
77
Food Network
Chopped . . . . . . . . . . . . . . . . . . . .
Cutthroat Kitchen . . . . . . . . . . . . . .
Diners, Drive-ins and Dives . . . . . .
Guy’s Grocery Games . . . . . . . . . .
Restaurant Impossible . . . . . . . . . .
78
79
80
81
82
Fox News Channel
The Five . . . . . . . . . . . . . . . . . . . . .
Fox and Friends . . . . . . . . . . . . . . .
Hannity. . . . . . . . . . . . . . . . . . . . . .
The Kelly File . . . . . . . . . . . . . . . . .
The O’Reilly Factor. . . . . . . . . . . . .
83
84
85
86
87
Baby Daddy . . . . . . . . . . . . . . . . . .
The Fosters . . . . . . . . . . . . . . . . . .
Pretty Little Liars . . . . . . . . . . . . . .
Shadowhunters . . . . . . . . . . . . . . .
Young and Hungry . . . . . . . . . . . . .
Freeform (formerly ABC Family)
1
6
8
9
0
88
89
90
91
92
FX
American Crime Story . . . . . . . . . .
American Horror Story . . . . . . . . . .
The Americans. . . . . . . . . . . . . . . .
FX Prime Movie . . . . . . . . . . . . . . .
The Strain . . . . . . . . . . . . . . . . . . .
93
94
95
96
97
Chesapeake Shores . . . . . . . . . . .
Golden Girls. . . . . . . . . . . . . . . . . .
Good Witch . . . . . . . . . . . . . . . . . .
Home & Family . . . . . . . . . . . . . . .
When Calls the Heart. . . . . . . . . . .
Watched Watched
last
last
30 days 7 days
If you watched the
days, how much
attention were
you paying?
Full Most Some
1
6
8
9
0
Hallmark Channel
History Channel
98
99
100
101
102
Alone . . . . . . . . . . . . . . . . . . . . . . .
American Pickers . . . . . . . . . . . . . .
Pawn Stars. . . . . . . . . . . . . . . . . . .
Swamp People . . . . . . . . . . . . . . . .
Vikings . . . . . . . . . . . . . . . . . . . . . .
103
104
105
106
107
Home & Garden Television
Fixer Upper . . . . . . . . . . . . . . . . . .
Flip or Flop. . . . . . . . . . . . . . . . . . .
House Hunters. . . . . . . . . . . . . . . .
Love It or List It . . . . . . . . . . . . . . .
Property Brothers. . . . . . . . . . . . . .
HLN
108 Issues With Jane Velez-Mitchell. . .
109 Morning Express with Robin Meade.
110 Nancy Grace . . . . . . . . . . . . . . . . .
Hulu
111
112
113
114
115
Casual . . . . . . . . . . . . . . . . . . . . . .
Deadbeat . . . . . . . . . . . . . . . . . . . .
Difficult People . . . . . . . . . . . . . . . .
11.22.63 . . . . . . . . . . . . . . . . . . . . .
The Path. . . . . . . . . . . . . . . . . . . . .
Investigation Discovery
116
117
118
119
120
Deadline Crime with Tamron Hall . .
Fear Thy Neighbor . . . . . . . . . . . . .
Obsession: Dark Desires . . . . . . . .
On the Case with Paula Zahn . . . .
See No Evil . . . . . . . . . . . . . . . . . .
CABLE/SATELLITE/STREAMING TV NETWORKS
CABLE/SATELLITE/
STREAMING TV
NETWORKS
(Continued)
66X
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
ION
Blue Bloods . . . . . . . . . . . . . . . . . .
Criminal Minds. . . . . . . . . . . . . . . .
Law & Order . . . . . . . . . . . . . . . . .
Law & Order: Special Victims Unit .
Saving Hope . . . . . . . . . . . . . . . . .
Lifetime
Bring It . . . . . . . . . . . . . . . . . . . . . .
Dance Moms . . . . . . . . . . . . . . . . .
Devious Maids . . . . . . . . . . . . . . . .
Project Runway . . . . . . . . . . . . . . .
Unreal . . . . . . . . . . . . . . . . . . . . . .
MTV
Awkward . . . . . . . . . . . . . . . . . . . .
The Challenge . . . . . . . . . . . . . . . .
Real World . . . . . . . . . . . . . . . . . . .
Teen Mom . . . . . . . . . . . . . . . . . . .
Teen Wolf . . . . . . . . . . . . . . . . . . . .
Watched Watched
last
last
30 days 7 days
National Geographic Channel
Brain Games . . . . . . . . . . . . . . . . .
Life Below Zero . . . . . . . . . . . . . . .
Live Free or Die . . . . . . . . . . . . . . .
Story of God . . . . . . . . . . . . . . . . .
Wicked Tuna. . . . . . . . . . . . . . . . . .
Netflix
Fuller House . . . . . . . . . . . . . . . . .
House of Cards . . . . . . . . . . . . . . .
Love. . . . . . . . . . . . . . . . . . . . . . . .
Orange Is the New Black . . . . . . . .
Unbreakable Kimmy Schmidt . . . .
146
147
148
149
150
Nickelodeon
Blaze . . . . . . . . . . . . . . . . . . . . . . .
Game Shakers. . . . . . . . . . . . . . . .
Paw Patrol . . . . . . . . . . . . . . . . . . .
SpongeBob SquarePants . . . . . . .
Teenage Mutant Ninja Turtles . . . .
151
152
153
154
155
Bar Rescue . . . . . . . . . . . . . . . . . .
Family Takeover . . . . . . . . . . . . . . .
Ink Master . . . . . . . . . . . . . . . . . . .
Ink Master Redemption . . . . . . . . .
Lip Sync Battle. . . . . . . . . . . . . . . .
If you watched the
days, how much
attention were
you paying?
Full Most Some
Page 68
CABLE/SATELLITE/
STREAMING TV
NETWORKS
(Continued)
66X
Watched Watched
last
last
30 days 7 days
If you watched the
days, how much
attention were
you paying?
Full Most Some
156
157
158
159
160
Syfy
Face Off . . . . . . . . . . . . . . . . . . . .
Killjoys . . . . . . . . . . . . . . . . . . . . . .
The Magicians . . . . . . . . . . . . . . . .
12 Monkeys . . . . . . . . . . . . . . . . . .
Z Nation . . . . . . . . . . . . . . . . . . . . .
161
162
163
164
165
TBS
American Dad Originals. . . . . . . . .
Angie Tribeca . . . . . . . . . . . . . . . . .
Conan . . . . . . . . . . . . . . . . . . . . . .
The Detour. . . . . . . . . . . . . . . . . . .
Samantha Bee. . . . . . . . . . . . . . . .
166
167
168
169
170
TLC
Little People, Big World . . . . . . . . .
Long Island Medium . . . . . . . . . . .
My Big Fat Fabulous Life . . . . . . . .
My Giant Life . . . . . . . . . . . . . . . . .
Sister Wives . . . . . . . . . . . . . . . . . .
171
172
173
174
175
TNT
Animal Kingdom. . . . . . . . . . . . . . .
The Last Ship. . . . . . . . . . . . . . . . .
Major Crimes . . . . . . . . . . . . . . . . .
Murder in the First . . . . . . . . . . . . .
Rizzoli & Isles . . . . . . . . . . . . . . . .
176
177
178
179
180
truTV
Adam Ruins Everything . . . . . . . . .
Billy on the Street . . . . . . . . . . . . .
The Carbonaro Effect. . . . . . . . . . .
Hack My Life . . . . . . . . . . . . . . . . .
Impractical Jokers . . . . . . . . . . . . .
181
182
183
184
185
186
USA Network
Chrisley Knows Best . . . . . . . . . . .
Modern Family . . . . . . . . . . . . . . . .
Mr. Robot . . . . . . . . . . . . . . . . . . .
Suits. . . . . . . . . . . . . . . . . . . . . . . .
WWE Raw . . . . . . . . . . . . . . . . . . .
WWE SmackDown . . . . . . . . . . . .
187
188
189
190
191
The Weather Channel
AMHQ . . . . . . . . . . . . . . . . . . . . . .
Prospectors . . . . . . . . . . . . . . . . . .
Strangest Weather on Earth . . . . .
Weather Center Live . . . . . . . . . . .
Weather Underground . . . . . . . . . .
Spike TV
1
6
8
9
0
1
6
8
9
0
TELEVISION VIEWING
Page 69
SPORTS PROGRAMS
68X
1. Did you
watch any
program when
it was shown
on television in
the past 12
months?
2. How many times a month do you
usually watch the following
programs?
program in the
past 12 months,
how much attention
were you paying?
program in the
past 12 months,
where did you
watch it?
Somewhere
Else
None
One
Two
Three
Four
Full
Most
Some
Your Own
Home
22
CBS College Football Today . . . . . . . . . . .
CBS NFL Regular Season Football . . . . .
CBS NFL Thursday Night Games . . . . . .
CBS NFL Thursday Night
Pre-Game Show . . . . . . . . . . . . . . . . . .
CBS The NFL Today . . . . . . . . . . . . . . . . .
23
24
25
26
27
ESPN College Football Games. . . . . . . . .
ESPN NFL Monday Night Football . . . . . .
ESPN Sunday NFL Countdown . . . . . . . .
Football Night in America . . . . . . . . . . . . .
FOX College Football Regular Season . . .
28
29
30
31
32
FOX College Saturday Pre-Game . . . . . . .
FOX NFL Regular Season Games . . . . . .
FOX NFL Sunday Pre-Game Show . . . . .
NBC NFL Thursday Night Games . . . . . . .
NBC NFL Thursday Night
Pre-Game Show . . . . . . . . . . . . . . . . . .
NBC NFL Sunday Night Football . . . . . . .
NBC Notre Dame Football . . . . . . . . . . . .
NBC Sports Network College Football
Regular Season . . . . . . . . . . . . . . . . . .
NFC Championship on FOX . . . . . . . . . . .
NFL Network Regular Season Games . . .
NFL Network Thursday Night Games . . . . NFL Network Thursday Night
Pre-Game Show . . . . . . . . . . . . . . . . . . 6
X
1
2
3
4
8
9
0
5
4
Yes
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
33
34
35
36
37
38
39
40
41
42
43
44
BASEBALL
ESPN MLB Regular Season Games . . . . FOX Saturday Baseball. . . . . . . . . . . . . . . TBS MLB Regular Season Baseball . . . . . BASKETBALL
ABC NBA Countdown . . . . . . . . . . . . . . . .
ABC NBA Regular Season Games . . . . . .
ABC Saturday Night NBA . . . . . . . . . . . . .
ABC WNBA Regular Season Games . . . .
CBS NCAA Men’s College
Basketball Games . . . . . . . . . . . . . . . . .
ESPN NBA Basketball Regular
Season Games . . . . . . . . . . . . . . . . . . .
ESPN NCAA Men’s College Basketball . .
FOX College Basketball . . . . . . . . . . . . . .
TNT NBA Basketball Regular
Season Games . . . . . . . . . . . . . . . . . . .
FOOTBALL
ABC College Football Countdown . . . . . .
ABC College Football Regular Season . . .
ABC Saturday Night College Football . . . .
AFC Championship on CBS . . . . . . . . . . .
CBS College Football Games . . . . . . . . . .
OTHER
CBS Sports Spectacular . . . . . . . . . . . . . .
ESPN Sports Saturday . . . . . . . . . . . . . . .
NBC Action Sports . . . . . . . . . . . . . . . . . .
NBC Sports Special . . . . . . . . . . . . . . . . .
WWE Main Event . . . . . . . . . . . . . . . . . . .
OLYMPICS
How likely are you to watch the 2016 Summer Olympics in Rio de Janeiro,
Brazil airing in August 2016?
68J-0
Very likely 1
Somewhat likely 2
Not very likely 3
Not at all likely 4
TELEVISION VIEWING
SEASONAL SPORTS
Page 70
1. Did you watch any
program when it was
shown on television in
the past 12 months?
2. If you watched the program
in the past 12 months, how
much attention were you
paying?
Yes
Full
Most
Some
Your Own
Home
Someone
Else’s Home
Hotel/Motel
6
8
9
0
5
1
6
3
4
68N
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
BASEBALL
ABC Little League World Series . . . . . . . .
ESPN Little League World Series . . . . . . .
FOX Major League Baseball World Series
FOX MLB Championship Series . . . . . . . .
FOX MLB Divisional Playoffs . . . . . . . . . . .
MLB Wild Card Game . . . . . . . . . . . . . . . .
TBS MLB Championship Series . . . . . . . .
TBS MLB Divisional Series . . . . . . . . . . . .
BASKETBALL
ABC NBA Finals. . . . . . . . . . . . . . . . . . . . .
ABC NBA Playoffs . . . . . . . . . . . . . . . . . . .
ABC WNBA Championship Finals . . . . . . .
ABC WNBA Playoffs . . . . . . . . . . . . . . . . .
CBS NCAA Men’s Basketball Tournament .
ESPN NBA Playoffs. . . . . . . . . . . . . . . . . .
SEC Championship . . . . . . . . . . . . . . . . . .
TBS NCAA Basketball Tournament. . . . . .
TNT NBA Playoffs . . . . . . . . . . . . . . . . . . .
TNT NCAA Basketball Tournament. . . . . .
TRU NCAA Basketball Tournament . . . . .
FOOTBALL
CBS NFL Football Playoffs . . . . . . . . . . . .
CBS NFL Pre-Season Games . . . . . . . . . .
DIRECTV NFL Sunday Ticket . . . . . . . . . .
ESPN NFL Football Playoffs . . . . . . . . . . .
ESPN NFL Pre-Season Football . . . . . . . .
FOX NFL Football Playoffs . . . . . . . . . . . .
FOX NFL Pre-Season Games . . . . . . . . . .
NBC NFL Football Playoffs . . . . . . . . . . . .
NBC NFL Pre-Season Games. . . . . . . . . .
NFL Network Pre-Season Football . . . . . .
NFL RedZone . . . . . . . . . . . . . . . . . . . . . .
HOCKEY
NBC NHL Hockey Playoffs. . . . . . . . . . . . .
NBC NHL Hockey Regular Season Games .
NBC Sports Network NHL Hockey
Playoffs. . . . . . . . . . . . . . . . . . . . . . . . . .
NBC Sports Network NHL Hockey
Regular Season Games. . . . . . . . . . . . .
NHL Stanley Cup Finals. . . . . . . . . . . . . . .
SOCCER
FOX Bundesliga Soccer. . . . . . . . . . . . . . .
FOX Major League Soccer . . . . . . . . . . . .
FOX UEFA Champions League . . . . . . . . .
NBC Major League Soccer . . . . . . . . . . . .
NBC Sports Network Major League
Soccer . . . . . . . . . . . . . . . . . . . . . . . . . .
NBC Premier League Soccer. . . . . . . . . . .
NBC Sports Network Premier League
Soccer . . . . . . . . . . . . . . . . . . . . . . . . . .
ANNUAL SPORTS
EVENTS/SPECIALS
68P
3. If you watched the program in the past 12
months, where did you watch it? (Check as
many as apply.)
1. Did you watch any program when it was
shown on television in the past 12
months?
2. If you watched any program in the past 12
many as apply.)
Watched
Past 12
months
Yes
01
02
03
04
05
06
07
08
09
10
AUTO RACING
ABC NASCAR Countdown . . . . . . . . . . . .
Formula 1 on NBC . . . . . . . . . . . . . . . . . .
Formula 1 on NBC Sports Network . . . . .
Indianapolis 500 . . . . . . . . . . . . . . . . . . . .
Indianapolis 500 Pre-Race Show . . . . . . .
IndyCar Series . . . . . . . . . . . . . . . . . . . . .
NASCAR Daytona 500 . . . . . . . . . . . . . . .
NASCAR Sprint Cup Series on FOX . . . .
NASCAR Sprint Cup Series on NBC . . . .
NASCAR Xfinity Series on FOX . . . . . . . .
11
12
BASEBALL
FOX Major League All-Star Game . . . . . . Home Run Derby . . . . . . . . . . . . . . . . . . . 6
Where Watched
Your
Someone SomeOwn
Else’s
where
Home
Home
Else
5
1
4
Bar/
Somewhere
Restaurant
Else
1. Did you watch any program when it was shown on television in the
past 12 months?
2. If you watched any program in the past 12 months, where did you
watch it? (Check as many as apply.)
Watched
Past 12
months
Yes
13
14
15
16
17
18
19
20
21
22
23
24
25
BASKETBALL
NBA All Star Game . . . . . . . . . . . . . . . . . .
NCAA Atlantic 10 Championship . . . . . . .
NCAA Basketball Championship
Selection Show . . . . . . . . . . . . . . . . . . .
NCAA Big East Tournament . . . . . . . . . . .
NCAA Big Ten Championship . . . . . . . . . .
NCAA Men’s Basketball Championship
Game . . . . . . . . . . . . . . . . . . . . . . . . . .
NCAA Men’s Division II Basketball
Championship . . . . . . . . . . . . . . . . . . . .
NCAA Men’s Final Four . . . . . . . . . . . . . . .
NCAA Missouri Valley Conference
Championship . . . . . . . . . . . . . . . . . . . .
NCAA Mountain West Championship . . . .
NCAA Road to the Final Four . . . . . . . . . .
NCAA SEC Championship . . . . . . . . . . . .
PAC-12 Championship . . . . . . . . . . . . . . .
Where Watched
Your
Someone SomeOwn
Else’s
where
Home
Home
Else
6
5
1
4
TELEVISION VIEWING
Page 71
ANNUAL SPORTS
EVENTS/SPECIALS
(Continued)
68P
shown on television in the past 12 months?
many as apply.)
Watched
Past 12
months
Yes
1. Did you watch any program when it was shown on television in the past
12 months?
2. If you watched any program in the past 12 months, where did you watch
it? (Check as many as apply.)
Watched Past
12 months
Where Watched
Your
Someone SomeOwn
Else’s
where
Home
Home
Else
ANNUAL SPORTS
EVENTS/SPECIALS (Continued)
Yes
77
78
79
80
81
GOLF (Continued)
RBC Canadian Open . . . . . . . . . . . . . . . .
RBC Heritage . . . . . . . . . . . . . . . . . . . . . .
Ryder Cup . . . . . . . . . . . . . . . . . . . . . . . . .
Senior British Open. . . . . . . . . . . . . . . . . .
Senior PGA Championship . . . . . . . . . . . .
82
83
84
85
86
Shell Houston Open . . . . . . . . . . . . . . . . .
The Tour Championship . . . . . . . . . . . . . .
Travelers Championship . . . . . . . . . . . . . .
U.S. Amateur Championship . . . . . . . . . . .
U.S. Open . . . . . . . . . . . . . . . . . . . . . . . . .
87
88
89
90
91
U.S. Senior Open . . . . . . . . . . . . . . . . . . .
U.S. Women’s Open . . . . . . . . . . . . . . . . .
Valero Texas Open . . . . . . . . . . . . . . . . . .
Valspar Championship . . . . . . . . . . . . . . .
Waste Management Phoenix Open . . . . .
92
93
94
95
96
Wells Fargo Championship . . . . . . . . . . . .
WGC—Bridgestone Invitational . . . . . . . .
WGC—Cadillac . . . . . . . . . . . . . . . . . . . .
WGC—Dell Match Play . . . . . . . . . . . . . .
Women’s British Open . . . . . . . . . . . . . . .
97 Wyndham Championship . . . . . . . . . . . . . 98 Zurich Classic of New Orleans . . . . . . . . . HORSE RACING
Belmont Stakes . . . . . . . . . . . . . . . . . . . . .
FOX Jockey Club Horse Racing . . . . . . . .
Kentucky Derby. . . . . . . . . . . . . . . . . . . . .
NBC Breeder’s Cup . . . . . . . . . . . . . . . . .
NBC Sports Network Horse Racing . . . . .
Where Watched
Your
Someone SomeOwn
Else’s
where
Home
Home
Else
FOOTBALL
AFC/NFC Pro Bowl Game . . . . . . . . . . . .
Army-Navy Game . . . . . . . . . . . . . . . . . . .
AT&T ESPN All American Team Show . . .
Celebration Bowl . . . . . . . . . . . . . . . . . . . .
Citrus Bowl . . . . . . . . . . . . . . . . . . . . . . . .
32
33
34
35
College Football Playoff National
Championship . . . . . . . . . . . . . . . . . . . .
Cotton Bowl . . . . . . . . . . . . . . . . . . . . . . . .
ESPN NFL Draft . . . . . . . . . . . . . . . . . . . .
Fiesta Bowl . . . . . . . . . . . . . . . . . . . . . . . .
Heisman Trophy . . . . . . . . . . . . . . . . . . . .
36
37
38
39
40
Las Vegas Bowl. . . . . . . . . . . . . . . . . . . . .
NFL Network NFL Draft . . . . . . . . . . . . . .
Orange Bowl . . . . . . . . . . . . . . . . . . . . . . .
Peach Bowl . . . . . . . . . . . . . . . . . . . . . . . .
Pinstripe Bowl . . . . . . . . . . . . . . . . . . . . . .
41
42
43
44
45
Rose Bowl . . . . . . . . . . . . . . . . . . . . . . . . .
SEC Championship Game . . . . . . . . . . . .
Sugar Bowl . . . . . . . . . . . . . . . . . . . . . . . .
Sun Bowl. . . . . . . . . . . . . . . . . . . . . . . . . .
Super Bowl . . . . . . . . . . . . . . . . . . . . . . . .
46
47
Super Bowl Post-Game Show . . . . . . . . . Super Bowl Pre-Game Show . . . . . . . . . . 48
49
50
51
52
GOLF
ADT Skills Challenge . . . . . . . . . . . . . . . .
Arnold Palmer Invitational . . . . . . . . . . . . .
AT&T Byron Nelson Championship . . . . .
AT&T Pebble Beach National Pro-Am . . . .
The Barclays . . . . . . . . . . . . . . . . . . . . . . .
53
54
55
56
57
BMW Championship . . . . . . . . . . . . . . . . .
British Open/Open Championship . . . . . .
Colonial National Invitation Tournament . .
Deutsche Bank Championship . . . . . . . . .
Farmers Insurance Open . . . . . . . . . . . . .
58
59
60
61
62
FedEx St. Jude Classic . . . . . . . . . . . . . . .
Franklin Templeton Shootout. . . . . . . . . . .
The Greenbrier Classic . . . . . . . . . . . . . . .
Honda Classic. . . . . . . . . . . . . . . . . . . . . .
John Deere Classic . . . . . . . . . . . . . . . . . .
63
64
65
66
67
LPGA Tour Championship . . . . . . . . . . . .
The Masters . . . . . . . . . . . . . . . . . . . . . . .
the Memorial Tournament presented by
Nationwide . . . . . . . . . . . . . . . . . . . . . .
Northern Trust Open . . . . . . . . . . . . . . . . .
Northwestern Mutual World Challenge . . .
68
69
70
71
72
PGA Championship . . . . . . . . . . . . . . . . .
PGA of America Specials . . . . . . . . . . . . .
PGA Tour on Golf Channel . . . . . . . . . . . .
PGA TOUR Specials . . . . . . . . . . . . . . . . .
PGA/USGA Specials. . . . . . . . . . . . . . . . .
117 Wimbledon . . . . . . . . . . . . . . . . . . . . . . . . 118 Wimbledon Highlights . . . . . . . . . . . . . . . . 73
74
75
76
The Players Championship . . . . . . . . . . . .
PNC Father/Son Challenge . . . . . . . . . . .
The President’s Cup . . . . . . . . . . . . . . . . .
Quicken Loans National . . . . . . . . . . . . . .
119
120
121
122
6
5
1
4
6
5
1
4
26
27
28
29
30
31
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
Preakness Stakes . . . . . . . . . . . . . . . . . . .
Road to the Kentucky Derby . . . . . . . . . . .
Santa Anita Derby . . . . . . . . . . . . . . . . . . .
Summer at Saratoga/Road to
Breeder’s Cup . . . . . . . . . . . . . . . . . . . .
SKATING
ISU Grand Prix . . . . . . . . . . . . . . . . . . . . .
NBC Skating Specials. . . . . . . . . . . . . . . .
U.S. Figure Skating Championships . . . . .
World Figure Skating Championships . . . .
TENNIS
Australian Open . . . . . . . . . . . . . . . . . . . .
French Open . . . . . . . . . . . . . . . . . . . . . . .
U.S. Open Tennis on ESPN . . . . . . . . . . .
U.S. Open Tennis—Men’s Championship .
U.S. Open Tennis—Women’s
Championship . . . . . . . . . . . . . . . . . . . .
TRACK & FIELD
Adidas Grand Prix . . . . . . . . . . . . . . . . . . .
Prefontaine Classic . . . . . . . . . . . . . . . . . .
U.S. Track & Field Championships . . . . . .
World Track & Field Championships . . . . .
TELEVISION VIEWING
ANNUAL SPORTS
EVENTS/SPECIALS
(Continued)
Page 72
shown on television in the past 12 months?
many as apply.)
68P
Watched
Past 12
months
ANNUAL SPORTS
EVENTS SPECIALS (Continued)
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
OTHER SPORTS
Alli Dew Tour . . . . . . . . . . . . . . . . . . . . . . .
CBS 15/15 Bucking Battle Bull Riding . . . .
CBS Premier Boxing Champions . . . . . . .
CBS PBR Bull Riding Series. . . . . . . . . . .
Deer Valley Celebrity Skifest . . . . . . . . . . .
Global Rally Cross Championship . . . . . .
Jeep World Adventure . . . . . . . . . . . . . . . .
Lucas Oil Drag Boat Racing Series . . . . .
Lucas Oil Late Model Dirt Series . . . . . . .
Lucas Oil Off Road Racing Series
Pro4 & Pro2 . . . . . . . . . . . . . . . . . . . . . .
Lucas Oil Pro Pulling League . . . . . . . . . .
Major League Fishing - 2015 Cup
Championships . . . . . . . . . . . . . . . . . . .
NYC Marathon . . . . . . . . . . . . . . . . . . . . .
Red Bull Signature Series . . . . . . . . . . . . .
Summer X Games . . . . . . . . . . . . . . . . . .
Tour de France . . . . . . . . . . . . . . . . . . . . .
U.S. Swimming Championship . . . . . . . . .
UFC on FOX . . . . . . . . . . . . . . . . . . . . . . .
USSA Skiing . . . . . . . . . . . . . . . . . . . . . . .
Winter X Games . . . . . . . . . . . . . . . . . . . .
World Cup Soccer - Men’s . . . . . . . . . . . .
World Cup Soccer - Women’s . . . . . . . . . .
World Gymnastics Championships . . . . . .
World Swimming Championships . . . . . . .
WrestleMania . . . . . . . . . . . . . . . . . . . . . .
ENTERTAINMENT/NEWS SPECIALS
01 ABC Academy Awards . . . . . . . . . . . . . . . .
02 ABC American Music Awards . . . . . . . . . . .
03 ABC Annual Country Music Association
Awards (CMA) . . . . . . . . . . . . . . . . . . . .
04 ABC Barbara Walters Specials . . . . . . . . . .
05 ABC 20/20 Specials . . . . . . . . . . . . . . . . . .
06 Academy of Country Music Awards. . . . . . .
07 Academy of Country Music Presents . . . . .
08 ACM: Presents An All-Star Tribute
to the Troops . . . . . . . . . . . . . . . . . . . . .
09 Adele Live in New York . . . . . . . . . . . . . . . .
10 An American Celebration at Ford’s Theater
11 American Country Awards. . . . . . . . . . . . . .
12 American Masters . . . . . . . . . . . . . . . . . . . .
13 Big Brother . . . . . . . . . . . . . . . . . . . . . . . . .
14 Blake Shelton’s Not So Family Christmas . .
15 BrainDead . . . . . . . . . . . . . . . . . . . . . . . . . .
16 A Capitol Fourth . . . . . . . . . . . . . . . . . . . . .
17 CBS Kennedy Center Honors . . . . . . . . . . .
18 CBS Thanksgiving Day Parade . . . . . . . . . .
19 Charlie Brown Specials . . . . . . . . . . . . . . . .
20 Christmas in Rockefeller Center . . . . . . . . .
21 CMA Music Festival Television Special . . . .
22 Coat Of Many Colors . . . . . . . . . . . . . . . . . .
23 Daytime Emmy Awards . . . . . . . . . . . . . . . .
24 Dick Clark’s New Years Rockin’ Eve with
Ryan Seacrest . . . . . . . . . . . . . . . . . . . .
25 Elf: Buddy’s Musical Christmas . . . . . . . . . .
26 ESPY Awards . . . . . . . . . . . . . . . . . . . . . . .
27 Flight Before Christmas. . . . . . . . . . . . . . . .
28 FOX New Year’s Special . . . . . . . . . . . . . . .
29 Fox 25th Anniversary Special . . . . . . . . . . .
30 Frosty the Snowman Specials. . . . . . . . . . .
31 Golden Globe Awards . . . . . . . . . . . . . . . . .
32 Grammy Awards . . . . . . . . . . . . . . . . . . . . .
33 Grammy Nominations Concert . . . . . . . . . .
34 Grammy Presents . . . . . . . . . . . . . . . . . . . .
35 The Great American Baking Show . . . . . . .
Yes
2. If you watched any program in the past 12 months, where did you watch
it? (Check as many as apply.)
68R
Where Watched
Your
Someone SomeOwn
Else’s
where
Home
Home
Else
68R
6
1. Did you watch any program when it was shown on television in the past
12 months?
5
1
4
Watched Past
12 months
Yes
Where Watched
Your
Someone SomeOwn
Else’s
where
Home
Home
Else
ENTERTAINMENT/NEWS SPECIALS
(Continued)
Great Christmas Light Fight . . . . . . . . . . . .
Great Performances . . . . . . . . . . . . . . . . . .
A Home for the Holidays . . . . . . . . . . . . . . .
Hunted . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I Love Lucy Christmas Special . . . . . . . . . .
41 Independent Lens . . . . . . . . . . . . . . . . . . . .
42 Jimmy Kimmel Live After The
Academy Awards . . . . . . . . . . . . . . . . . .
43 Kelly Clarkson . . . . . . . . . . . . . . . . . . . . . . .
44 Ken Burns Films . . . . . . . . . . . . . . . . . . . . .
45 The Kennedy Center Mark Twain Prize . . . .
46 Live From Lincoln Center . . . . . . . . . . . . . .
47 Macy’s Fourth of July Fireworks
Spectacular . . . . . . . . . . . . . . . . . . . . . . .
48 Macy’s Thanksgiving Day Parade . . . . . . . .
49 Mat Franco’s Got Magic . . . . . . . . . . . . . . .
50 Michael Buble Christmas . . . . . . . . . . . . . .
51
52
53
54
55
Miss Universe Pageant . . . . . . . . . . . . . . . .
Miss USA Pageant . . . . . . . . . . . . . . . . . . .
Murray Saves Christmas . . . . . . . . . . . . . . .
NFL Honors . . . . . . . . . . . . . . . . . . . . . . . . .
National Dog Show . . . . . . . . . . . . . . . . . . .
56
57
58
59
60
National Memorial Day Concert . . . . . . . . .
New Year’s Eve Live . . . . . . . . . . . . . . . . . .
New Year’s Eve With Carson Daly . . . . . . . .
Oscar’s Red Carpet Live . . . . . . . . . . . . . . .
People’s Choice Awards . . . . . . . . . . . . . . .
61
62
63
64
65
POV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Prep & Landing . . . . . . . . . . . . . . . . . . . . . .
Primetime Emmy Awards . . . . . . . . . . . . . .
Primetime News Specials . . . . . . . . . . . . . .
The Reaper . . . . . . . . . . . . . . . . . . . . . . . . .
66
67
68
69
70
Red Nose Day . . . . . . . . . . . . . . . . . . . . . . .
Rudolph the Red-Nosed Reindeer . . . . . . .
Rudolph’s Shiny New Year. . . . . . . . . . . . . .
Saturday Night Live Specials . . . . . . . . . . .
Secrets of the Dead . . . . . . . . . . . . . . . . . .
71
72
73
74
75
Shrek the Halls . . . . . . . . . . . . . . . . . . . . . .
Sinatra 100: An All-Star Grammy Concert . .
Soul Train Music Awards . . . . . . . . . . . . . . .
The Story of Santa Claus . . . . . . . . . . . . . .
Super Bowl’s Greatest Commercials . . . . . .
76
77
78
79
80
Superbook. . . . . . . . . . . . . . . . . . . . . . . . . .
Teen Choice Awards . . . . . . . . . . . . . . . . . .
The Ten Commandments (1956). . . . . . . . .
A Toast to 2015 . . . . . . . . . . . . . . . . . . . . . .
Tony Awards . . . . . . . . . . . . . . . . . . . . . . . .
81
82
83
84
85
Tournament of Roses Parade . . . . . . . . . . .
Toy Story of Terror . . . . . . . . . . . . . . . . . . . .
Toy Story That Time Forgot . . . . . . . . . . . . .
Victoria’s Secret Fashion Show . . . . . . . . . .
Victoria’s Secret Swim Special . . . . . . . . . .
86
87
88
89
Walt Disney Specials . . . . . . . . . . . . . . . . .
The Wiz Live . . . . . . . . . . . . . . . . . . . . . . . .
Yes, Virginia. . . . . . . . . . . . . . . . . . . . . . . . .
Zoo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
36
37
38
39
40
6
5
1
4
TELEVISION VIEWING — SPANISH LANGUAGE
Page 73
SPANISH
TELEVISION
VIEWING
66A
Listed below are television programs that are shown Monday through Friday. Please check in the appropriate columns below.
1. How many times a week
2. Did you watch the 3. If you watched the 4. If you watched the
do you usually watch the
program yesterday
program yesterday,
program yesterday,
following programs?
(if today is Sunday
how much attention
where did you watch it?
or Monday, did you
were you paying?
watch the program
on Friday)?
Your
Someone
SomeOwn
Home
Else’s
Home
At
Work
where
Else
5
6
8
9
0
5
1
2
4
1
2
3
4
5
Yes
Full
01
02
NEWS
None
Noticiero Telemundo . . . . . . . . . . . . Noticiero Univision . . . . . . . . . . . . . . 03
04
EARLY MORNING PROGRAMS
Despierta América . . . . . . . . . . . . . .
Un Nuevo Dia. . . . . . . . . . . . . . . . . .
05
06
07
08
09
10
11
12
DAYTIME
Caso Cerrado. . . . . . . . . . . . . . . . . .
Casos De Familia . . . . . . . . . . . . . .
Como Dice El Dicho. . . . . . . . . . . . .
Hoy . . . . . . . . . . . . . . . . . . . . . . . . .
Laura . . . . . . . . . . . . . . . . . . . . . . . .
Lo Mejor del Caso Cerrado . . . . . . .
La Rosa De Guadalupe . . . . . . . . . .
Suelta La Sopa . . . . . . . . . . . . . . . .
13
14
15
16
17
18
19
MONDAY THROUGH FRIDAY PROGRAMS
Al Rojo Vivo con María Celeste . . .
Caso Cerrado Edición Estelar . . . .
El Chavo . . . . . . . . . . . . . . . . . . . .
Cineplex. . . . . . . . . . . . . . . . . . . . .
El Gordo y La Flaca . . . . . . . . . . . .
Primer Impacto. . . . . . . . . . . . . . . .
Veredicto Final . . . . . . . . . . . . . . . . 20
21
22
23
24
25
26
27
LATE NIGHT SHOWS
Cineplex. . . . . . . . . . . . . . . . . . . . .
Cinescape . . . . . . . . . . . . . . . . . . .
Choques Extremos . . . . . . . . . . . .
Decisiones . . . . . . . . . . . . . . . . . . .
Desmadrugados . . . . . . . . . . . . . .
Estrellados . . . . . . . . . . . . . . . . . . .
La Familia P. Luche . . . . . . . . . . . .
Noticiero Univision: Edición Nocturna
X
1
2
3
4
66C
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
Most Some
Listed below are television programs that are shown once a week. Please check in the appropriate columns below.
1. How many times a
2. Did you watch
month do you usually
the program
program in the past
in the past 7 days, where
watch the following
in the past 7
7 days, how much
did you watch it?
programs?
days?
attention were you
paying?
None
Al Punto . . . . . . . . . . . . . . . . . . . . . Aquí y Ahora . . . . . . . . . . . . . . . . . Aventura Animal . . . . . . . . . . . . . . La Banda . . . . . . . . . . . . . . . . . . . . Cásate Conmigo . . . Mi Amor . . . . El Chavo Animado . . . . . . . . . . . . . Cine De Las Estrellas . . . . . . . . . . Cine en Casa . . . . . . . . . . . . . . . . . Cine En Familia . . . . . . . . . . . . . . . Cine Especial. . . . . . . . . . . . . . . . . Cine Exclusivo . . . . . . . . . . . . . . . . Cine Millonario . . . . . . . . . . . . . . . . Cineplex. . . . . . . . . . . . . . . . . . . . . Cinescape . . . . . . . . . . . . . . . . . . . Como Dice El Dicho. . . . . . . . . . . . La CQ . . . . . . . . . . . . . . . . . . . . . . Derecho De Admisión . . . . . . . . . . Enfoque . . . . . . . . . . . . . . . . . . . . . La Familia P. Luche . . . . . . . . . . . . Gran Hermano . . . . . . . . . . . . . . . . Lánzate . . . . . . . . . . . . . . . . . . . . . Netas Divinas. . . . . . . . . . . . . . . . . Noticiero Univision - Fin de Semana Nuestra Belleza Latina. . . . . . . . . . Parodiando VIP . . . . . . . . . . . . . . . Planeta U . . . . . . . . . . . . . . . . . . . Plaza Sésamo . . . . . . . . . . . . . . . . Qué Noche con Angélica y Raúl . . El Reino Animal . . . . . . . . . . . . . . Sabadazo . . . . . . . . . . . . . . . . . . . Sal y Pimienta . . . . . . . . . . . . . . . . Va Por Ti 2 . . . . . . . . . . . . . . . . . . . La Voz Kids . . . . . . . . . . . . . . . . . . Ya Era Hora con Erika y Eduardo . X
1
2
3
4
Yes
Full
1
2
3
4
6
8
Most Some
9
0
Your
Own
Home
Someone
Else’s
Home
Hotel/
Motel
Somewhere
Else
5
1
6
4
TELEVISION VIEWING — SPANISH LANGUAGE
SPORTS
program when it was
the past 12 months?
2. How many times a
month do you usually
watch the following
programs?
Page 74
in the past 12 months, how
much attention were you
paying?
in the past 12 months,
where did you watch it?
66E
SPORTS PROGRAMS
Yes
None
One
Two
Three
Four
Full
Most
Some
Your Own
Home
Somewhere
Else
01
02
03
04
05
Contacto Deportivo . . . . . . . . . . . . . . . . .
Fútbol Central . . . . . . . . . . . . . . . . . . . . .
Liga Mexicana De Fútbol . . . . . . . . . . . .
Lucha Underground . . . . . . . . . . . . . . . .
República Deportiva . . . . . . . . . . . . . . . .
06
07
08
Sólo Boxeo . . . . . . . . . . . . . . . . . . . . . . . Titulares y Más . . . . . . . . . . . . . . . . . . . . Titulares Telemundo . . . . . . . . . . . . . . . . X
1
2
3
4
8
9
0
5
4
6
66F
program when it was
the past 12 months?
2. If you watched the program in
the past 12 months, how much
attention were you paying?
3. If you watched the program in the past 12 months,
where did you watch it? (check as many as apply.)
Yes
Full
Most
Some
Your
Own
Home
01
02
03
04
05
Boxeo Telemundo . . . . . . . . . . . . . . . . . . .
CONCACAF Champions League . . . . . . .
Copa América . . . . . . . . . . . . . . . . . . . . . .
Copa Oro . . . . . . . . . . . . . . . . . . . . . . . . .
Fútbol Estelar . . . . . . . . . . . . . . . . . . . . . .
06
07
08
Major League Soccer . . . . . . . . . . . . . . . .
Superliga . . . . . . . . . . . . . . . . . . . . . . . . .
USA vs Mexico Friendlies . . . . . . . . . . . .
SEASONAL SPORTS
6
SOAP OPERAS/
NOVELAS
8
9
1. Did you watch any program when it was shown
on television in the past 12 months?
66H
Yes
01 TELEMUNDO:
(Imperio, El Secreto de Fatmagul, Secretos) . . . . . . . . . . . .
02 UNIMAS:
(Hasta Que El Dinero Nos Separe,
Por Ella Soy Eva, Vecinos) . . . . . . . . . . . . . . . . . . . . . . . . . .
03 UNIVISION:
(Amores Verdaderos, La Vecina) . . . . . . . . . . . . . . . . . . . . . .
PRIME TIME
05 UNIMAS:
(Lady La Vendedora de Rosas, La Viuda Negra 2,
Ruta 35) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
06 UNIVISION:
(Antes Muerta Que Lichita, El Hotel de los Secretos,
Muchacha Italiana Viene a Casarse, Pasión y Poder) . . . . .
6
5
ANNUAL EVENTS/
SPECIALS
Watched
Past 12
months
DAYTIME
04 TELEMUNDO:
(Bajo el Mismo Cielo, La Doña, Eva La Trailera,
Quién Es Quién, La Querida del Centauro,
El Señor de los Cielos, Señora Acero 2) . . . . . . . . . . . . . . .
0
66L
Someone
Else’s
Home
Hotel/
Motel
Bar
Restaurant
Somewhere
Else
1
6
3
4
1. Did you watch any program when it was shown
on television in the past 12 months?
many as apply.)
Watched
Past 12
months
ANNUAL EVENTS/SPECIALS
Yes
01 Alfombra de Premios Tu Mundo . . . . . . . . . . 02 La Alfombra Roja de Billboard. . . . . . . . . . . . 03 The Bible . . . . . . . . . . . . . . . . . . . . . . . . . . . 04 Cine Especial . . . . . . . . . . . . . . . . . . . . . . . . 05 Detrás de la Fama. . . . . . . . . . . . . . . . . . . . . Where Watched
Your
Someone SomeOwn
Else’s
where
Home
Home
Else
06
07
08
09
10
El Desfile de las Rosas . . . . . . . . . . . . . . . . .
Es El Momento . . . . . . . . . . . . . . . . . . . . . . .
Feliz Año Nuevo . . . . . . . . . . . . . . . . . . . . . .
El Grito de México. . . . . . . . . . . . . . . . . . . . .
I Heart Radio Fiesta Latina . . . . . . . . . . . . . .
11
12
13
14
Latin AMA’s . . . . . . . . . . . . . . . . . . . . . . . . . .
Latin Billboard Music Awards . . . . . . . . . . . .
Latin Grammy . . . . . . . . . . . . . . . . . . . . . . . .
Las Mañanitas a la Virgen de Guadalupe . .
15
16
17
18
19
Miss Venezuela . . . . . . . . . . . . . . . . . . . . . . .
Nuestra Belleza de México . . . . . . . . . . . . . .
Nuestra Navidad . . . . . . . . . . . . . . . . . . . . . .
Premio Lo Nuestro . . . . . . . . . . . . . . . . . . . .
Premios Billboard: Acceso VIP . . . . . . . . . . .
20
21
22
23
24
25
Premios Juventud . . . . . . . . . . . . . . . . . . . . .
Premios Oye . . . . . . . . . . . . . . . . . . . . . . . .
Premios Tu Mundo . . . . . . . . . . . . . . . . . . . .
Premios “TV y Novelas”. . . . . . . . . . . . . . . . .
Premios Univision Deportes . . . . . . . . . . . . .
Social Media Awards . . . . . . . . . . . . . . . . . . .
26 Teletón . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Univision Documentales . . . . . . . . . . . . . . . . 5
1
4
6
TELEVISION NETWORKS
Page 75
TELEVISION NETWORKS
66Y
Did you watch any
program from
Did you watch any
this network ONLINE
program from
using a computer,
this network using
cell phone, etc.,
VIDEO-ON-DEMAND,
in the past 30 days? in the past 30 days?
Network
01 ABC. . . . . . . . . . . . . . . . . . . . . . . . .
02 A&E. . . . . . . . . . . . . . . . . . . . . . . . .
03 Adult Swim . . . . . . . . . . . . . . . . . . .
04 Al Jazeera America . . . . . . . . . . . . .
05 AMC . . . . . . . . . . . . . . . . . . . . . . . .
TELEVISION
CABLE AND NETWORKS
SATELLITE
TELEVISION
(Continued)
NETWORKS
Did you watch any
program from
Did you watch any
this network ONLINE
program from
using a computer,
this network using
cell phone, etc.,
VIDEO-ON-DEMAND,
in the past 30 days? in the past 30 days?
71
72
73
74
75
IFC TV . . . . . . . . . . . . . . . . . . . . . . .
INSP (The Inspiration Network) . . .
Investigation Discovery . . . . . . . . . .
ION . . . . . . . . . . . . . . . . . . . . . . . . . .
Lifetime . . . . . . . . . . . . . . . . . . . . . .
76
77
78
79
80
LMN (Lifetime Movie Network) . . . .
Logo . . . . . . . . . . . . . . . . . . . . . . . .
MAVTV . . . . . . . . . . . . . . . . . . . . . .
MeTV . . . . . . . . . . . . . . . . . . . . . . .
MLB Network . . . . . . . . . . . . . . . . .
81
82
83
84
85
MSNBC News . . . . . . . . . . . . . . . . .
The Movie Channel . . . . . . . . . . . .
MTV (Music Television) . . . . . . . . . .
MTV 2 . . . . . . . . . . . . . . . . . . . . . . .
MTV Tr3s. . . . . . . . . . . . . . . . . . . . .
86
87
88
89
90
Music Choice . . . . . . . . . . . . . . . . .
Nat Geo Wild. . . . . . . . . . . . . . . . . .
National Geographic Channel . . . . .
NBA TV . . . . . . . . . . . . . . . . . . . . . .
NBC . . . . . . . . . . . . . . . . . . . . . . . .
91
92
93
94
95
NBC Sports Network. . . . . . . . . . . .
NFL Network . . . . . . . . . . . . . . . . . .
Nick at Nite . . . . . . . . . . . . . . . . . . .
Nick Jr. . . . . . . . . . . . . . . . . . . . . . .
Nickelodeon . . . . . . . . . . . . . . . . . .
96
97
98
99
100
Outdoor Channel. . . . . . . . . . . . . . .
Ovation TV . . . . . . . . . . . . . . . . . . .
OWN (Oprah Winfrey Network) . . .
Oxygen . . . . . . . . . . . . . . . . . . . . . .
Palladia HD . . . . . . . . . . . . . . . . . . .
101
102
103
104
105
PBS. . . . . . . . . . . . . . . . . . . . . . . . .
PBS KIDS . . . . . . . . . . . . . . . . . . . .
Pivot . . . . . . . . . . . . . . . . . . . . . . . .
POP . . . . . . . . . . . . . . . . . . . . . . . .
QVC . . . . . . . . . . . . . . . . . . . . . . . .
106
107
108
109
110
Reelz Channel. . . . . . . . . . . . . . . . .
RFD-TV (Rural Free Delivery TV) . .
SCI . . . . . . . . . . . . . . . . . . . . . . . . .
Showtime . . . . . . . . . . . . . . . . . . . .
Smithsonian Channel . . . . . . . . . . .
111
112
113
114
115
Spike TV . . . . . . . . . . . . . . . . . . . . .
Sportsman Channel . . . . . . . . . . . .
Sprout . . . . . . . . . . . . . . . . . . . . . . .
Starz . . . . . . . . . . . . . . . . . . . . . . . .
SundanceTV . . . . . . . . . . . . . . . . . .
116
117
118
119
120
Syfy . . . . . . . . . . . . . . . . . . . . . . . . .
TBS . . . . . . . . . . . . . . . . . . . . . . . . .
TeenNick . . . . . . . . . . . . . . . . . . . . .
Tennis Channel . . . . . . . . . . . . . . . .
TLC . . . . . . . . . . . . . . . . . . . . . . . . .
06
07
08
09
10
American Heroes Channel . . . . . . .
Animal Planet . . . . . . . . . . . . . . . . .
BabyFirst . . . . . . . . . . . . . . . . . . . . .
BBC America. . . . . . . . . . . . . . . . . .
BBC World News . . . . . . . . . . . . . . .
11
12
13
14
15
BET (Black Entertainment TV) . . . . . .
Bloomberg Television. . . . . . . . . . . .
Bounce TV . . . . . . . . . . . . . . . . . . .
BRAVO . . . . . . . . . . . . . . . . . . . . . .
Cartoon Network . . . . . . . . . . . . . . .
16
17
18
19
20
CBS. . . . . . . . . . . . . . . . . . . . . . . . .
CBS Sports Network . . . . . . . . . . . .
Centric. . . . . . . . . . . . . . . . . . . . . . .
Chiller . . . . . . . . . . . . . . . . . . . . . . .
Cinemax . . . . . . . . . . . . . . . . . . . . .
21
22
23
24
25
CLOO . . . . . . . . . . . . . . . . . . . . . . .
CMT (Country Music Television) . . .
CNBC . . . . . . . . . . . . . . . . . . . . . . .
CNN . . . . . . . . . . . . . . . . . . . . . . . .
Comedy Central . . . . . . . . . . . . . . . .
26
27
28
29
30
Cooking Channel. . . . . . . . . . . . . . .
CW . . . . . . . . . . . . . . . . . . . . . . . . . .
Destination America . . . . . . . . . . . .
Discovery Channel . . . . . . . . . . . . .
Discovery Family . . . . . . . . . . . . . . .
31
32
33
34
35
Discovery Life Channel . . . . . . . . . .
Disney Channel . . . . . . . . . . . . . . . .
Disney Junior . . . . . . . . . . . . . . . . . .
Disney XD . . . . . . . . . . . . . . . . . . . .
DIY Network . . . . . . . . . . . . . . . . . .
36
37
38
39
40
E! (Entertainment Television) . . . . . .
Encore . . . . . . . . . . . . . . . . . . . . . . .
EPIX . . . . . . . . . . . . . . . . . . . . . . . .
ESPN . . . . . . . . . . . . . . . . . . . . . . .
ESPN2 . . . . . . . . . . . . . . . . . . . . . .
41
42
43
44
45
ESPNU. . . . . . . . . . . . . . . . . . . . . . .
ESPN Classic. . . . . . . . . . . . . . . . . .
ESPN News . . . . . . . . . . . . . . . . . . .
Esquire Network . . . . . . . . . . . . . . .
Flix . . . . . . . . . . . . . . . . . . . . . . . . .
46
47
48
49
50
FM. . . . . . . . . . . . . . . . . . . . . . . . . .
Food Network. . . . . . . . . . . . . . . . . .
FOX . . . . . . . . . . . . . . . . . . . . . . . . .
Fox Business Network . . . . . . . . . .
Fox News Channel . . . . . . . . . . . . .
51
52
53
54
55
Fox Sports 1. . . . . . . . . . . . . . . . . . .
Fox Sports 2. . . . . . . . . . . . . . . . . . .
Freeform . . . . . . . . . . . . . . . . . . . . .
Fuse . . . . . . . . . . . . . . . . . . . . . . . .
FX . . . . . . . . . . . . . . . . . . . . . . . . .
56
57
58
59
60
FXM (FX Movie Channel) . . . . . . . .
FXX . . . . . . . . . . . . . . . . . . . . . . . . .
FYI . . . . . . . . . . . . . . . . . . . . . . . . . .
Galavision. . . . . . . . . . . . . . . . . . . . .
Golf Channel . . . . . . . . . . . . . . . . . .
121
122
123
124
125
Travel Channel . . . . . . . . . . . . . . . .
truTV . . . . . . . . . . . . . . . . . . . . . . . .
TNT . . . . . . . . . . . . . . . . . . . . . . . . .
TCM (Turner Classic Movies) . . . . .
TV Land . . . . . . . . . . . . . . . . . . . . .
61
62
63
64
65
GAC (Great American Country) . . .
GSN (Game Show Network). . . . . .
Hallmark Channel . . . . . . . . . . . . . .
Hallmark Movies & Mysteries. . . . . .
History Channel . . . . . . . . . . . . . . .
66
67
68
69
70
H2 . . . . . . . . . . . . . . . . . . . . . . . . . .
HBO . . . . . . . . . . . . . . . . . . . . . . . .
HGTV (Home & Garden Television) . .
HLN. . . . . . . . . . . . . . . . . . . . . . . . .
HSN (Home Shopping Network) . . .
126
127
128
129
130
TV One . . . . . . . . . . . . . . . . . . . . . .
UP Uplifting Entertainment . . . . . . .
USA Network . . . . . . . . . . . . . . . . .
Velocity . . . . . . . . . . . . . . . . . . . . . .
Vh1 . . . . . . . . . . . . . . . . . . . . . . . . .
131
132
133
134
Vh1 Classic . . . . . . . . . . . . . . . . . . .
The Weather Channel . . . . . . . . . . .
WE tv . . . . . . . . . . . . . . . . . . . . . . .
WGN America . . . . . . . . . . . . . . . . .
1
2
1
2
MOVIE ATTENDANCE/MOVIE VIEWING: AT THEATER, ON VIDEO
MOVIE
ATTENDANCE
69A-0
Did you attend the movies . . .
in the last 12 months? Yes 1
Yes 3
MOVIE VIEWING
(Continued)
No 2
No 4
How often did you attend the movies in the last 90 days (3 months)?
Once a week or more . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2-3 times a month . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Once a month . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Less than once a month . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
6
7
8
Do you prefer to see a new movie:
Opening weekend . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
After opening weekend, but within the first 2 weeks . . . . . . . . . . . . . . . 0
After the second week. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X
Theaters you visited in the last 12 months:
AMC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Carmike. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Cinemark/Century . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Marcus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
National Amusements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Regal Cinemas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other theater . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
69B-0
1
2
3
4
5
6
7
In the last 12 months did you attend a movie . . .
In 3D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . In an Imax theater . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
9
69C
MOVIE VIEWING
Have you seen any of the following movies in the last 6 months at a
movie theater? on DVD, Blu-ray disc, or video tape (either rented or
purchased)? with Video-On-Demand or Pay-Per-View through your cable/
satellite provider? Downloaded/Streamed over the Internet?
Movie Title
Saw at
Movie
Theater
past 6
months
Viewed on
DVD,
Blu-ray or
Video Tape
Rented Purchased
past 6
past 6
months months
Viewed
Downwith
loaded
Video
or
On
Streamed
Demand from the
or PPV Internet,
past 6
past 6
months months
A Walk in the Woods . . . . . . . .
The Age of Adaline. . . . . . . . . .
Aloha . . . . . . . . . . . . . . . . . . . .
Alvin & The Chipmunks:
Road Chip. . . . . . . . . . . . . . .
Ant-Man . . . . . . . . . . . . . . . . . .
The Avengers: Age of Ultron . .
The Big Short . . . . . . . . . . . . . .
Black Mass . . . . . . . . . . . . . . . .
Blackhat . . . . . . . . . . . . . . . . . .
The Boy Next Door . . . . . . . . .
Bridge of Spies. . . . . . . . . . . . .
Brooklyn . . . . . . . . . . . . . . . . . .
Chappie . . . . . . . . . . . . . . . . . .
Cinderella . . . . . . . . . . . . . . . . .
Concussion. . . . . . . . . . . . . . . .
Creed . . . . . . . . . . . . . . . . . . . .
Crimson Peak. . . . . . . . . . . . . .
Daddy’s Home . . . . . . . . . . . . .
Entourage. . . . . . . . . . . . . . . . .
Everest . . . . . . . . . . . . . . . . . . .
Fantastic Four . . . . . . . . . . . . .
Fifty Shades of Grey . . . . . . . .
Furious 7. . . . . . . . . . . . . . . . . .
The Gallows . . . . . . . . . . . . . . .
Get Hard. . . . . . . . . . . . . . . . . .
The Good Dinosaur . . . . . . . . .
Goosebumps . . . . . . . . . . . . . .
The Hateful Eight . . . . . . . . . . .
Hitman: Agent 47 . . . . . . . . . . .
Home . . . . . . . . . . . . . . . . . . . .
Hot Pursuit . . . . . . . . . . . . . . . .
Hot Tub Time Machine 2 . . . . .
Hotel Transylvania 2 . . . . . . . . .
The Hunger Games:
Mockingjay Pt.2 . . . . . . . . . .
In the Heart of the Sea . . . . . .
1
2
3
4
5
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
Movie Title
Saw at
Movie
Theater
past 6
months
Viewed on
DVD,
Blu-ray or
Video Tape
Rented Purchased
past 6
past 6
months months
Page 76
Viewed
Downwith
loaded
Video
or
On
Streamed
Demand from the
or PPV Internet,
past 6
past 6
months months
Inside Out . . . . . . . . . . . . . . . . .
Insurgent . . . . . . . . . . . . . . . . .
The Intern . . . . . . . . . . . . . . . . .
Joy . . . . . . . . . . . . . . . . . . . . . .
Jupiter Ascending. . . . . . . . . . .
Jurassic World . . . . . . . . . . . . .
Kingsman: The Secret Service.
Krampus . . . . . . . . . . . . . . . . . .
The Last Witch Hunter . . . . . . .
Lazarus. . . . . . . . . . . . . . . . . . .
The Longest Ride . . . . . . . . . .
Love the Coopers. . . . . . . . . . .
Mad Max. . . . . . . . . . . . . . . . . .
Magic Mike XXL . . . . . . . . . . . .
The Man from U.N.C.L.E. . . . .
The Martian . . . . . . . . . . . . . . .
Max. . . . . . . . . . . . . . . . . . . . . .
Maze Runner:
The Scorch Trials . . . . . . . . .
McFarland, USA. . . . . . . . . . . .
Minions . . . . . . . . . . . . . . . . . . .
Mission Impossible:
Rogue Nation . . . . . . . . . . . .
Monkey Kingdom . . . . . . . . . . .
Mortdecai . . . . . . . . . . . . . . . . .
The Night Before . . . . . . . . . . .
No Escape . . . . . . . . . . . . . . . .
Paddington . . . . . . . . . . . . . . . .
Pan . . . . . . . . . . . . . . . . . . . . . .
Paper Towns. . . . . . . . . . . . . . .
Paul Blart: Mall Cop 2 . . . . . . .
Pitch Perfect 2 . . . . . . . . . . . . .
Pixels . . . . . . . . . . . . . . . . . . . .
Point Break . . . . . . . . . . . . . . . .
Poltergeist. . . . . . . . . . . . . . . . .
Project Almanac . . . . . . . . . . . .
Ricki and the Flash . . . . . . . . .
Ride Along 2. . . . . . . . . . . . . . .
San Andreas. . . . . . . . . . . . . . .
Seventh Son. . . . . . . . . . . . . . .
Shaun The Sheep Movie . . . . .
Sicario . . . . . . . . . . . . . . . . . . .
Sinister 2 . . . . . . . . . . . . . . . . .
Sisters. . . . . . . . . . . . . . . . . . . .
Southpaw . . . . . . . . . . . . . . . . .
Spare Parts . . . . . . . . . . . . . . .
Spectre . . . . . . . . . . . . . . . . . . .
SPY. . . . . . . . . . . . . . . . . . . . . .
Star Wars: The Force
Awakens . . . . . . . . . . . . . . . .
Straight Outta Compton . . . . . .
Taken 3 . . . . . . . . . . . . . . . . . . .
Ted 2. . . . . . . . . . . . . . . . . . . . .
Terminator: Genisys . . . . . . . . .
The Peanuts Movie . . . . . . . . .
The Perfect Guy . . . . . . . . . . . .
The Revenant. . . . . . . . . . . . . .
The Spongebob Movie:
Sponge Out of Water . . . . . .
Tomorrowland. . . . . . . . . . . . . .
Trainwreck . . . . . . . . . . . . . . . .
Unfinished Business . . . . . . . .
Unfriended . . . . . . . . . . . . . . . .
Vacation . . . . . . . . . . . . . . . . . .
The Visit . . . . . . . . . . . . . . . . . .
War Room . . . . . . . . . . . . . . . .
The Water Diviner . . . . . . . . . .
The Wedding Ringer . . . . . . . .
Woman in Gold . . . . . . . . . . . .
96
97
98
99
100
1
2
3
4
5
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
CONSUMER ATTITUDES
Page 77
69K
IN THE NEXT TWELVE MONTHS, HOW LIKELY ARE YOU OR SOMEONE IN YOUR HOUSEHOLD TO:
YOUR INTENTIONS
Home:
Buy your first house/residence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Buy a second house/or vacation home . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Sell your house/residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Take out a 2nd Mortgage or Equity Loan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Remodel your home:
Remodel Kitchen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Remodel Bathroom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Convert room to home office . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Add rooms – Exterior Additions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Buy insurance or financial products:
Homeowner or personal property . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Life insurance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Auto insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Invest in stocks, bonds, or mutual funds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Travel: Vacation within the U.S.:
Hawaii . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Florida . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Theme Park . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Cruise: (for more than 1 day) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Travel: Vacation abroad:
Europe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Caribbean . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mexico . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
South America . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Vehicle:
Buy a new vehicle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Buy a used or pre-owned vehicle. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Lease a vehicle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Buy/lease vehicle type:
2-door car . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4-door car . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Van/Mini-van . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Motorcycle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Sport Utility Vehicle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Truck . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Hybrid/Alternative Fuel Vehicle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Buy electronics:
E-reader (e.g. Amazon Kindle) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Tablet (e.g. Apple iPad) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Smartwatch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Home theater system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Large flat screen/HDTV (27" - 42") . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Giant flat screen/HDTV (43" or more) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Blu-ray player . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Digital video camera/Digital camera . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Desktop computer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Laptop computer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Satellite Radio . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Smartphone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Lifestyle (you personally):
Get engaged . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Become a parent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Become a grandparent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Have a child go away to college. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Have a child graduate from college . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Have a child get married . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Retire from full-time work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Rollover from pension/IRA/401(k) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Collect lump-sum from pension/IRA/401(k) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Start or buy a new business. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Start or return to school . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Change jobs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Get a dog or cat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
CONSUMER
CONFIDENCE
Very
Likely
Somewhat
Likely
Not Very
Likely
Not at all
Likely
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
1
2
3
4
69M-0
Thinking of the last 12 months, do you believe that you and your household are better off or worse off financially than you were one year ago?
Better now 1
About the same 2
Worse now 3
Thinking of the next 12 months, do you think you and your household will be better off or worse off financially one year from now?
Better 4
About the same 5
Worse 6
Thinking of the last 12 months, do you believe that the economy and business conditions in the country as a whole are better or worse now than one year ago?
Better now 7
About the same 8
Worse now 9
Thinking of the next 12 months, do you think that the economy and business conditions in the country as a whole will be better or worse one year from now?
Better 0
About the same X
Worse Y
GENERAL ATTITUDES/INTEREST IN ADVERTISING
Page 78
The following items help us to understand how General Attitudes about lifestyles relate to needs for and use of specific products and services. Please
indicate how much you disagree or agree with each of the following statements by circling the number that comes closest to describing how you feel.
There are no right or wrong answers — just answers that describe you best. (Please circle one number in each row.)
DISAGREE
69E
11. I am often interested in theories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
AGREE
Mostly
Somewhat
Somewhat
Mostly
1
2
3
4
12. I often ask people’s advice about clothes, vacations, and
other spending decisions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
2
3
4
13. A good negotiator doesn’t just get the food in the bowl, but the bowl itself . .
1
2
3
4
14. I love to make things I can use everyday . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
2
3
4
15. I follow the latest trends and fashions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
2
3
4
16. Just as the Bible says, the world literally was created in six days . . . . . . . . .
1
2
3
4
17. I like being in charge of a group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
2
3
4
18. I like to learn about art, culture, and history . . . . . . . . . . . . . . . . . . . . . . . . .
1
2
3
4
19. I often crave excitement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
2
3
4
10. I am really interested in only a few things . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
2
3
4
11. I would rather make something than buy it . . . . . . . . . . . . . . . . . . . . . . . . . .
1
2
3
4
12. I dress more fashionably than most people . . . . . . . . . . . . . . . . . . . . . . . . .
1
2
3
4
13. The federal government should encourage prayers in public schools. . . . . .
1
2
3
4
14. I have more ability than most people . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
2
3
4
15. I consider myself an intellectual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
2
3
4
16. Only a fool gives more than they get . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
2
3
4
17. I like trying new things . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
2
3
4
18. I am very interested in how mechanical things, such as engines, work . . . .
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19. I like to dress in the latest fashions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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20. There is too much sex on television today. . . . . . . . . . . . . . . . . . . . . . . . . . .
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21. I like to lead others . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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22. People who think too much annoy me . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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23. I like a lot of excitement in my life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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24. I must admit that my interests are somewhat narrow and limited . . . . . . . . .
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25. I like making things of wood, metal, or other such material. . . . . . . . . . . . . .
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26. I want to be considered fashionable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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27. Religion is the most important way to know what’s morally correct . . . . . . .
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28. I like the challenge of doing something I have never done before. . . . . . . . .
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29. No matter how much evil I see in the world, my faith in God is strong . . . . .
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30. I like to make things with my hands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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31. I am always looking for a thrill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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32. I like doing things that are new and different . . . . . . . . . . . . . . . . . . . . . . . .
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33. I like to look through hardware or automotive stores . . . . . . . . . . . . . . . . . .
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34. I would like to understand more about how the universe works . . . . . . . . . .
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35. I need to get the news everyday . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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36. I like outrageous people and things . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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37. I like a lot of variety in my life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
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38. I must admit that I like to show off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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39. I would like to spend a year or more in a foreign country . . . . . . . . . . . . . . .
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40. A woman’s life is fulfilled only if she can provide a happy home for her family.
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41. I like to learn about things even if they may never be of any use to me . . . .
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42. I like my life to be pretty much the same from week to week . . . . . . . . . . . .
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ATTITUDES
TOWARD
ADVERTISING
Please read the following statements and check the box that most closely reflects your opinion.
Does not describe
your attitude at all
63B
Describes your
attitude completely
Attitudes Toward Advertising
1. Advertising helps me keep up-to-date about products and services that I
need or would like to have. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2. Too many products do not perform as well as the ads claim. . . . . . . . . . . . .
3. Advertising is more manipulative than it is informative. . . . . . . . . . . . . . . . . .
4. Much of advertising is way too annoying. . . . . . . . . . . . . . . . . . . . . . . . . . . .
5. I like to look at advertising. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6. On average, brands that are advertised are better in quality than brands
that are not advertised. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
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PERSONAL VALUES
Page 79
PERSONAL VALUES
69N
Please rate on a scale of 1 to 7, with ‘1’ meaning not at all important and ‘7’ meaning extremely important. For each
personal value, please circle the number that best describes how important, if at all, it is to you as a guiding principle
in your life. You should mark values that are of average importance to you towards the middle of the scale.
How Important To You?
Not at all
important
1.
2.
3.
4.
5.
6.
7.
8.
9.
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Wealth: Having material possessions, a lot of money
Status: Achieving a higher social status
Ambition: Aspiring to get ahead
Honesty: Being sincere, having integrity
Being in tune with nature: Fitting into nature
Preserving the environment: Helping to preserve nature
Creativity: Being creative, imaginative
Freedom: Having freedom of action and thought
Curiosity: Wanting to explore and learn about new things
Public image: Protecting my reputation, saving face
Protecting the family: Having safety for loved ones
Social responsibility: Working for the welfare of society
Equality: Desiring equal opportunity for all
Stable personal relationships: Maintaining a long-term commitment to friends
and loved ones
Romance: Having romance in my life
Enjoying life: Doing things because I like them
Having fun: Having a good time
Adventure: Seeking adventure and risk
Sex: Achieving a fulfilling sexual life
Looking good: Seeking the utmost attractive appearance
Duty: Fulfilling obligations to family, community and country
Respecting ancestors: Showing respect for those who came before us
Traditional gender roles: Following traditional roles for men and women
Faith: Holding to religious faith and belief
Learning: Continuing to learn throughout my life
Helpfulness: Making the effort to assist others
Friendship: Having close, supportive friends
Power: Having control over people and resources
Open-mindedness: Being broad-minded
Social tolerance: Respecting ethnic, religious, and racial differences
Authenticity: Being true to myself
Self-reliance: Being self reliant, choosing my own goals
Tradition: Preserving time-honored customs
Being youthful: Feeling young
Excitement: Having stimulating experiences
Self-interest: Putting my interests ahead of others'
Knowledge: Being well educated
Simplicity: Keeping your life and mind as uncluttered as possible
Cultural purity: Keeping my culture free from outside influences
Working hard: Always giving my best effort
Modesty: Being modest, self-effacing
Thrift: Being economical or careful with money and avoiding excesses
Average
importance
Extremely
important
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YOUR ATTITUDES
Page 80
We are interested in your attitude about a number of issues. There are no right or wrong answers. Please indicate how much you AGREE or
DISAGREE with each of the following statements by checking the box that comes closest to how you feel.
DISAGREE
62Y
Completely
Somewhat
AGREE
Somewhat Completely
1
2
3
1.
2.
3.
4.
5.
I try to eat dinner with my family almost every night . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I am so busy, I often can’t finish everything I need to in a day. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I strive to achieve a high social status. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The government should pay more attention to environmental issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I like to shower my loved ones with gifts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
6.
7.
8.
9.
10.
I like to give the impression that my life is under control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Given the choice, I would be my own boss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Prayer is a part of my daily life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Marriage should only be legal between a man and a woman. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I am interested in finding out how I can help the environment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11.
12.
13.
14.
15.
I don’t mind giving up my personal time for work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Risk-taking is exciting to me . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I am very interested in the fine arts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I purchase products to help organize my life. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Religion should be the pillar of our society . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16.
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18.
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I often find myself in a leadership position . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I like to live a lifestyle that impresses others . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Spending time with my family is my top priority . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I work primarily for the salary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I prefer a set routine in my daily life. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
21.
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Global warming is a serious threat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I enjoy showing off my home to guests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I feel really good about seeing celebrities in the media that share my ethnic background.. . . . . . . . . . . . . . . .
I like to learn about foreign cultures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Keeping a neat, organized home is a top priority for me. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
26.
27.
28.
29.
30.
I feel I am more environmentally conscious than most people . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Even if things look messy, I know where everything is . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I consider myself sophisticated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I must admit, I work most weekends. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Children have a right to be spoiled . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
31.
32.
33.
34.
35.
I attend religious services regularly. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
My philosophy is “Life should be as much fun as possible.” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I am typically willing to pay more for high-quality items . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I’d rather prepare a meal than eat in a restaurant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
A company’s environmental record is important to me in my purchasing decisions . . . . . . . . . . . . . . . . . . . . .
36.
37.
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39.
40
I consider myself a spiritual person. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
My friends are the most important thing in my life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I often feel like my life is slipping out of control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I enjoy being the center of attention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
My goal is to make it to the top of my profession . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
41.
42.
43.
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45.
I seek out variety in my everyday life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
It’s important to me that my children continue my family’s cultural traditions. . . . . . . . . . . . . . . . . . . . . . . . . . .
Family is important to me, but I have other interests that are equally important . . . . . . . . . . . . . . . . . . . . . . . .
I consider myself to be very sociable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
People who are worried about the environment are overreacting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
46.
47.
48.
49.
50.
My cultural/ethnic heritage is an important part of who I am . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I frequently wish I had more time to spend with my family. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I would continue working even if I won the lottery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I make sure I take time for myself each day. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Juggling family and work demands is very stressful for me. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
51.
52.
53.
54.
55.
I see myself as somewhat of a loner. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
My home is an expression of my personal style . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I consider myself outspoken . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I enjoy maintaining traditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I’m more connected to my ethnic heritage than my parents are . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
56.
57.
58.
59.
60.
61.
62.
63.
I love keeping up with celebrity news and gossip . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
To me, it is important to keep up-to-date with news and current affairs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Pets deserve to be pampered. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I choose to have a small group of friends rather than a large group of acquaintances. . . . . . . . . . . . . . . . . . .
I avoid confrontation whenever possible. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I consider my work to be a career, not just a job. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I am willing to take charge to get things done . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I can tell my home is clean by the way it smells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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YOUR OPINION
Page 81
DISAGREE
AUTOMOTIVE
69F
1.
2.
3.
4.
5.
6.
7.
8.
9.
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I want a vehicle that has both the comforts of a car and the capabilities of a truck. . . . . . . . . . . . . . . . . . . . . .
I plan to buy the vehicle that best meets my needs no matter who makes it or in what country it is produced.
The vehicle a person owns says a lot about him or her. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I often take the opportunity to discuss my knowledge of automobiles with others. . . . . . . . . . . . . . . . . . . . . .
I’m loyal to my vehicle brands and stick with them . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I consider myself to be an automotive enthusiast. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I buy vehicles that reflect my commitment to support the environment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I seek out vehicles with bold, innovative designs that stand apart from others on the road.. . . . . . . . . . . . . . .
I think of vehicles as basic transportation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I look forward to technology advances in new vehicles. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The quality of workmanship/construction of a vehicle is more important than anything else.. . . . . . . . . . . . . .
I enjoy learning about automobiles from others. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I research and compare as many vehicles as possible before making my final purchase decision.. . . . . . . . .
When I find a vehicle that I like, I typically recommend it to people I know. . . . . . . . . . . . . . . . . . . . . . . . . . . .
My first consideration in choosing a vehicle is its exterior styling.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I look for vehicles that offer spirited performance and powerful acceleration. . . . . . . . . . . . . . . . . . . . . . . . . .
I typically look at several vehicle brands when shopping for a new vehicle . . . . . . . . . . . . . . . . . . . . . . . . . . .
Having a vehicle that is fun to drive is a top consideration in my purchasing decision. . . . . . . . . . . . . . . . . . .
I enjoy personalizing my vehicle to reflect my individual tastes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I often ask the advice of others when it comes to automobiles. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I prefer buying models of vehicles that I or people I know have owned and like. . . . . . . . . . . . . . . . . . . . . . . .
I want the cheapest and easiest to maintain vehicle I can find. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I generally purchase the most expensive model with all the luxury appointments and options. . . . . . . . . . . . .
People often ask my advice when it comes to automobiles. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Having a versatile vehicle to accommodate my busy lifestyle is important to me. . . . . . . . . . . . . . . . . . . . . . .
Rebates and incentives strongly influence my new vehicle purchase decisions. . . . . . . . . . . . . . . . . . . . . . . .
I consider safety first when shopping for a new vehicle. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I always follow the advice of my mechanic.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I always maintain my vehicle as recommended by the manufacturer’s manual. . . . . . . . . . . . . . . . . . . . . . . . .
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30. If you had to make a decision today, what new (not used) CAR or TRUCK would you buy or lease? Make
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VACATION TRAVEL
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DISAGREE
69L
On my vacations, I prefer traveling to places I’ve never been. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Concerns about security issues have made me less likely to travel.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Travel and hotel discounts have a strong influence on where I choose to travel and where I choose to stay.. .
I often take the opportunity to discuss knowledge of vacation options with others. . . . . . . . . . . . . . . . . . . . . .
In general, price is more important to me than convenience when making travel plans . . . . . . . . . . . . . . . . .
I’d rather book a trip over the Internet than meet with a travel agent. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Packaged deals are great, because I don’t have to plan out the details too much.. . . . . . . . . . . . . . . . . . . . . .
I love doing research on a location before I go on vacation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
When I learn about a great vacation, I typically recommend it to people I know. . . . . . . . . . . . . . . . . . . . . . . .
I’d rather travel by myself or with just a small group of people.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I frequently choose active vacations with lots to do. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
It’s worth it to me to pay more for high quality hotel accommodations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I’m happy to do very little, if any, sightseeing on my vacations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I enjoy learning about vacation options from others. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
When I find a vacation spot I like, I go back whenever I can. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I am willing to pay more for a flight in order to travel on my favorite airline. . . . . . . . . . . . . . . . . . . . . . . . . . . .
The best vacation is restful without too much physical exercise.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Group tours are fun and a good way to meet people. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
People often ask my advice when it comes to vacation travel. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I’d rather travel in the U.S. than to a foreign location. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The Internet is not a secure way to make travel plans. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I often ask the advice of others when it comes to vacation travel. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Last-minute travel specials are a great way to get a bargain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Traveling to foreign places is a great way for me to learn about other cultures. . . . . . . . . . . . . . . . . . . . . . . . .
I’d rather take a few weekend vacations than one long vacation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I prefer guided tours to traveling independently. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Planning a vacation is just as much fun as the trip itself. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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YOUR OPINION
Page 82
DISAGREE
FOOD
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I try to eat healthy these days and pay attention to my nutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I rarely eat frozen dinners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I typically celebrate special occasions at restaurants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
During a given week, I cook meals frequently. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If a food item is on sale, I buy multiple units to stock up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Often, I eat my meals on the run. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I rely on product labels to help me make decisions when food shopping. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I enjoy being creative in the kitchen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I try to eat a healthy breakfast every day . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I only buy food items that are name-brand, not generic brands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I evaluate the nutrition of menu items when ordering at a restaurant. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
When I find a food product I like, I typically recommend it to people I know . . . . . . . . . . . . . . . . . . . . . . . . . . .
I don’t allow junk food in my home . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
When I find a restaurant I like, I stick with it. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Frozen dinners are a convenient alternative for a meal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Eating at a fast food restaurant is fun. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If generic brands are on sale, I will purchase them over my normal name-brand. . . . . . . . . . . . . . . . . . . . . . .
I’m willing to spend more for a quality bottle of wine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I don’t have very much interest in cooking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I try to buy foods that are grown or produced locally (in the region where I live). . . . . . . . . . . . . . . . . . . . . . . .
I enjoy trying different types of food . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I indulge my cravings for sweets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Fast food is junk food. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I typically drink wine with dinner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
People often ask my advice when it comes to food. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I prefer picking up quick meals to cooking meals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I’m fine with eating at a restaurant by myself. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I don’t pay much attention to my intake of fat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Dinners in my home are usually planned ahead of time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I only eat fast food when I’m in a rush. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I prefer cooking with fresh food rather than canned or frozen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I’m a creature of habit, and stick to the food I know I like . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I let my children make their own decisions when ordering at a restaurant. . . . . . . . . . . . . . . . . . . . . . . . . . . .
I regularly eat organic foods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Food is a comfort to me . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I often use recipes when preparing a meal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I’m always on the lookout for quick and easy meal options .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I like to see healthier options at fast food restaurants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I use food to bring family together. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I am loyal to my food brands and stick with them . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I enjoy celebrating special occasions at home with family and friends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I rely on mobile coupons for deals while food shopping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I snack often . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I like to try new recipes when I entertain. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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YOUR OPINION
Page 83
For each of the following statements, please check off which media you think it describes — TV, radio, mobile internet,
internet on computer, magazines, newspapers. You can check off as many as you’d like. For example, if you think the
statement describes all of them, check off all six.
MEDIA
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A good source of learning . . . . . . . . . . .
Pure entertainment . . . . . . . . . . . . . . . . .
Makes me think . . . . . . . . . . . . . . . . . . .
Keeps me informed/up to date . . . . . . . .
A good escape . . . . . . . . . . . . . . . . . . . .
Relaxes me. . . . . . . . . . . . . . . . . . . . . . .
Puts me in a good mood. . . . . . . . . . . . .
Gives me good ideas . . . . . . . . . . . . . . .
Keeps me up-to-date with the latest
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TV
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NEWSPAPERS
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69Y-0
The one I trust the most (pick one). . . . .
TV 1
Radio 2
Mobile
Internet 3
Internet on
Computer 4
Magazines 5
Newspapers 6
Here is a list of different places where you might find advertising. We would like to know:
a. Have you seen advertising in these places in the last 6 months or in the last 30 days?
b. If yes, how much interest do you have in the advertising that appears in these places?
ADVERTISING
A. You Personally
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Have seen in Have seen in
last 6 months last 30 days
B. How much Interest do you have?
Considerable Interest
Some Interest
Not Much Interest
Billboards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Ads on buses/trains . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Ads at bus stops or train stations . . . . . . . . . . . . . . . . . . . .
Ads inside taxis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Ads on top of taxis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Ads at an airport . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Ads on phone booths . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Ads at sports or entertainment events . . . . . . . . . . . . . . . .
Ads on postcards. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Ads sent to a cell phone or other mobile device . . . . . . . . .
Ads on posters at movie theaters . . . . . . . . . . . . . . . . . . . .
Ads shown on-screen before the start of a movie . . . . . . . .
Ads on shopping carts. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Ads in stores (not video ads) . . . . . . . . . . . . . . . . . . . . . . . .
Ads in shopping malls (not video ads). . . . . . . . . . . . . . . . .
Video Ads in grocery stores. . . . . . . . . . . . . . . . . . . . . . . . .
Video Ads in drug stores . . . . . . . . . . . . . . . . . . . . . . . . . . .
Video Ads in convenience stores. . . . . . . . . . . . . . . . . . . . .
Video Ads in large discount/department stores . . . . . . . . . .
Video Ads in warehouse/club stores . . . . . . . . . . . . . . . . . .
Video Ads in other stores . . . . . . . . . . . . . . . . . . . . . . . . . .
Video Ads in shopping malls . . . . . . . . . . . . . . . . . . . . . . . .
Video Ads in shopping mall food courts . . . . . . . . . . . . . . .
Video Ads in bars/pubs . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Video Ads in fast food or family restaurants . . . . . . . . . . . .
Video Ads in coffee shops, cafes or delis . . . . . . . . . . . . . .
Video Ads in gyms/health clubs . . . . . . . . . . . . . . . . . . . . .
Video Ads in medical offices . . . . . . . . . . . . . . . . . . . . . . . .
Video Ads in airports . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Video Ads in taxis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Video Ads at gas stations . . . . . . . . . . . . . . . . . . . . . . . . . .
Video Ads in office building lobbies . . . . . . . . . . . . . . . . . .
Video Ads in office building elevators . . . . . . . . . . . . . . . . .
Video Ads in movie theater lobbies . . . . . . . . . . . . . . . . . .
Infomercials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Offers or Ads sent to your home by mail . . . . . . . . . . . . . . .
Product placement in video games . . . . . . . . . . . . . . . . . . .
Product placement in TV shows . . . . . . . . . . . . . . . . . . . . .
Product placement in movies . . . . . . . . . . . . . . . . . . . . . . .
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TECHNOLOGY
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to how you feel.
DISAGREE
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I enjoy reading about new technology products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I’m willing to pay more for top quality electronics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I often take the opportunity to discuss my knowledge of technology or electronic products with others . . . . .
Computers are too confusing to be of much use to me . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I give others advice when they are looking to buy technology or electronic products . . . . . . . . . . . . . . . . . . .
Computers can be a good source of entertainment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I’m fascinated by new technology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I enjoy learning about technology or electronic products from others . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Technology helps make my life more organized . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Before buying electronics, I do as much research as possible . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Technology has little impact on my daily life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
When I find a technology or electronic product I like, I typically recommend it to people I know . . . . . . . . . . .
I am among the first of my friends and colleagues to try new technology products . . . . . . . . . . . . . . . . . . . . .
At first, I was nervous about using computers, but now I’m much more comfortable . . . . . . . . . . . . . . . . . . . .
I often ask the advice of others when it comes to technology or electronic products . . . . . . . . . . . . . . . . . . . .
I like to read reviews before buying technology or electronics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I want others to say “wow” when they see my electronics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If I am to be able to use a new technology product, someone has to show me how to use it . . . . . . . . . . . . .
I like to have a lot of gadgets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I like to be connected, either by phone or Internet, at all times . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
To me, it’s important to always be reachable wherever I am. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Building electronics is a hobby of mine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
INTERNET/ONLINE
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
Page 84
to how you feel.
Completely
AGREE
Somewhat
Somewhat Completely
1
2
3
4
DISAGREE
69S
The Internet is a great way to gather information on products/services I’m considering purchasing . . . . . . . .
The Internet is a great way to actually buy products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The Internet has allowed me to learn things I probably wouldn’t have learned otherwise . . . . . . . . . . . . . . . .
The Internet is a great way to communicate with family/friends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The Internet is a main source of entertainment for me . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I like to keep my personal Internet pages updated with information about my life . . . . . . . . . . . . . . . . . . . . . .
I would feel disconnected without the Internet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Going online is one of my favorite things to do with my free time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The Internet is a good thing, but I worry that too much technology can be a bad thing . . . . . . . . . . . . . . . . . .
Instant messenger keeps me in touch with my friends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The Internet is a good way to meet new people . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I think people put too much private information about their lives on the Internet . . . . . . . . . . . . . . . . . . . . . . .
The Internet has little impact on my daily life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
In general, I’d rather shop online than go to a store.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Completely
Somewhat
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
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23.
24.
69J
I regularly read financial news or financial publications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I hate to borrow money; I would much rather save up in advance of a purchase . . . . . . . . . . . . . . . . . . . . . . .
My parents tend/tended to be savers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I would be happy to use the Internet to carry out day to day banking transactions. . . . . . . . . . . . . . . . . . . . . .
I often take the opportunity to discuss my knowledge of financial products or services with others. . . . . . . . .
I always know broadly how much is in my bank account at any one time. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
There are one or two financial institutions that I always turn to first . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
It is better for me to put my money in a low-risk investment, even if the return may not be as great . . . . . . . .
The way I deal with my finances reflects how my parents dealt with theirs. . . . . . . . . . . . . . . . . . . . . . . . . . . .
When I find a financial product or service that I like, I typically recommend it to people I know . . . . . . . . . . . .
You are better off having what you want now as you never know what tomorrow brings . . . . . . . . . . . . . . . . .
I like to take risks when investing for the chance of a high return . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I enjoy learning about financial products or services from others . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I only save for a specific purpose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Borrowing money makes me feel uncomfortable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
People often ask my advice when it comes to financial matters.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I hate having to go to the branch of my bank or savings institution. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I find the ups and downs of the financial markets exciting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I often ask the advice of others when it comes to financial products or services. . . . . . . . . . . . . . . . . . . . . . .
I’m happy to use the phone to carry out day to day banking transactions . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Investing in the stock market is too risky for me . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The economy has a direct effect on my spending habits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I feel overwhelmed by financial burdens. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Investing for the future is very important to me . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
AGREE
1
2
3
Completely
03
Somewhat Completely
DISAGREE
FINANCE
01
02
4
01
02
03
04
05
06
07
08
09
10
11
12
13
14
AGREE
Somewhat
Somewhat Completely
1
2
3
4
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
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18
19
20
21
22
23
24
WATCHING TV
Page 85
WATCHING TV
Do you watch TV programs in the following ways more often, the same amount, or less often than you did 12 months ago?
66T
On a TV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
On a desktop computer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
On a laptop computer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
On a tablet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
On a smartphone. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
At the time of airing (live) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Using a DVR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Using VOD (Video-On-Demand) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
“Binge-watching” (3 or more episodes in a sitting). . . . . . . . . . . . . . . .
Through my TV service provider’s website . . . . . . . . . . . . . . . . . . . . .
Through my TV service provider’s app . . . . . . . . . . . . . . . . . . . . . . . .
Through a TV network’s website . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Through a TV network’s app . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Through another online streaming TV service . . . . . . . . . . . . . . . . . . .
Thinking of how you prefer to watch TV programs,
how important to you are the following items?
66U
Screen size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Little/no commercials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Watching “on the go” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Watching whenever I want . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Easy access/log-in. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Watching alone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Watching with others . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
“Binge-watching” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Quality of programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Variety of programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Staying “up-to-date” on a series during its season . . . . . . . . . . . . . . .
Access to older episodes or seasons of a show . . . . . . . . . . . . . . . . .
Access to series no longer on the air . . . . . . . . . . . . . . . . . . . . . . . . .
Watching an episode live when it first airs . . . . . . . . . . . . . . . . . . . . . .
Talking about shows with my friends . . . . . . . . . . . . . . . . . . . . . . . . . .
More often
than last year
Same amount
as last year
Less often
than last year
Don’t watch
this way
01
02
03
04
05
06
07
08
09
10
11
12
13
14
1
2
3
4
Very
Important
Somewhat
Important
Not Very
Important
Not Important
at all
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
1
2
3
4
66V-0
Which of the following ways do you typically learn about new TV programs to watch?
Family and friends (via social networking posts/blogs) . . . . . . 1
Advertising/promotions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Family and friends (other ways/“word of mouth”) . . . . . . . . . . . 2
TV service provider’s website/app . . . . . . . . . . . . . . . . . . . . . . . . . .
“Liking” or “following” a network’s social networking site . . . . . 3
TV network’s website/app . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Reading or watching reviews . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Another online streaming TV service’s website /app . . . . . . . . . . . .
“Channel-surfing” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
MORE TV
WATCHING
Please indicate how much you AGREE or DISAGREE with each of the following statements by checking the box that
comes closest to how you feel.
DISAGREE
AGREE
66W
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.
I will often turn to my favorite TV channels, just to see what's on . . . . . . . . . . . . . . . . . .
It's important to me to be able to watch TV programs when I want and where I want . .
I have a few favorite networks that I always check out first. . . . . . . . . . . . . . . . . . . . . . .
I turn on TV only to watch my favorite shows . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I subscribe to online streaming TV services just for the original programming. . . . . . . .
Subscribing to online video services is totally worth the money . . . . . . . . . . . . . . . . . . .
Online access to TV programs means there's always something for me to watch . . . . .
Hooking my TV set up to the Internet to get more TV programming
is too much of a hassle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I watch more TV now overall than I did one year ago . . . . . . . . . . . . . . . . . . . . . . . . . . .
TV is more addictive now than ever before. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
TV is more engaging now than ever before . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
TV is more interesting now than ever before. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
There’s just too much junk on TV nowadays. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The quality of TV programming has improved in the last few years . . . . . . . . . . . . . . . .
When I can't fast forward through commercials, I feel frustrated . . . . . . . . . . . . . . . . . .
“Binge watching” episodes of a TV program is a great way to watch a series . . . . . . . .
There are shows that I want to watch, but I just don't have time. . . . . . . . . . . . . . . . . . .
I like to "save up" episodes of my favorite shows to watch more than one in a sitting . .
I would consider dropping my cable subscription if I could view my favorite
programs online for less money . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I would watch TV programs on my cell phone more often, if the screen size was bigger.
I only watch TV when I know I can skip commercials . . . . . . . . . . . . . . . . . . . . . . . . . . .
I often talk about TV shows with my friends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I like watching shows that everyone's talking about . . . . . . . . . . . . . . . . . . . . . . . . . . . .
It's important for me to watch TV programs when they first air so I don't accidentally
hear any "spoilers" . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I’m more likely to buy products or services advertised on networks I like . . . . . . . . . . .
I pay more attention to commercials on networks I like . . . . . . . . . . . . . . . . . . . . . . . . .
I often feel like I’m overwhelmed with choice when it comes to watching TV . . . . . . . . .
My family often watches different programs on different “screens”, but in the same room
I like watching TV together with my friends and family . . . . . . . . . . . . . . . . . . . . . . . . . .
Finding shows I can watch with my significant other is important to me. . . . . . . . . . . . .
Completely
Somewhat
Somewhat Completely
1
2
3
4
01
02
03
04
05
06
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08
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30
6
7
8
9
YOUR INTERESTS & ACTIVITIES
YOUR INTERESTS
Page 86
YOUR INTERESTS
(Continued)
Please read the following questions/statements
and check any box that applies.
Which, if any, of the following topics are:
A.
B.
C.
D.
E. Which, if any, of these people have you recommended any
product or service to in the past 12 months?
62K-0
Areas you feel you have a great deal of experience or knowledge in?
Topics your friends and family often ask for and trust your advice about?
Topics in which you are almost always among the first to try new things?
Topics you are really passionate about?
62J
C. I am almost
A. I have a
B. My family/
always among
great deal of friends often ask the first to try
knowledge/
for and trust my
new things
experience in
advice on this
relating to
this topic
topic
this topic
D. I am really
passionate
about
this topic
1
2
3
4
Healthcare. . . . . . . . . . . . . . . . . . .
Physical Fitness . . . . . . . . . . . . . .
Healthy Lifestyle . . . . . . . . . . . . . .
Environmentally-Friendly
products . . . . . . . . . . . . . . . . . . .
Prescription Drugs. . . . . . . . . . . . .
Dieting. . . . . . . . . . . . . . . . . . . . . .
Cooking. . . . . . . . . . . . . . . . . . . . .
Snacks . . . . . . . . . . . . . . . . . . . . .
New Food items . . . . . . . . . . . . . .
Grocery Shopping . . . . . . . . . . . . .
Cleaning products . . . . . . . . . . . . .
Beauty. . . . . . . . . . . . . . . . . . . . . .
Fashion - Clothes . . . . . . . . . . . . .
Fashion - Shoes . . . . . . . . . . . . . .
Other Fashion . . . . . . . . . . . . . . . .
Shopping. . . . . . . . . . . . . . . . . . . .
Wine . . . . . . . . . . . . . . . . . . . . . . .
Beer . . . . . . . . . . . . . . . . . . . . . . .
Other Alcoholic Beverages . . . . . .
Coffee . . . . . . . . . . . . . . . . . . . . . .
Soft Drinks . . . . . . . . . . . . . . . . . .
Automobiles . . . . . . . . . . . . . . . . .
Other Vehicles. . . . . . . . . . . . . . . .
Automotive Products . . . . . . . . . . .
Business Travel . . . . . . . . . . . . . . .
Vacation Travel . . . . . . . . . . . . . . .
Restaurants. . . . . . . . . . . . . . . . . .
Finance/Investments . . . . . . . . . . .
Real Estate . . . . . . . . . . . . . . . . . .
Insurance . . . . . . . . . . . . . . . . . . .
Business . . . . . . . . . . . . . . . . . . . .
Home Remodeling . . . . . . . . . . . .
Household Furnishings . . . . . . . . .
Interior Decorating . . . . . . . . . . . .
Gardening . . . . . . . . . . . . . . . . . . .
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
Computers. . . . . . . . . . . . . . . . . . .
Home Electronics . . . . . . . . . . . . .
New Technology . . . . . . . . . . . . . .
Mobile/Cell phones . . . . . . . . . . . .
Photography . . . . . . . . . . . . . . . . .
Video Games . . . . . . . . . . . . . . . .
Books . . . . . . . . . . . . . . . . . . . . . .
Movies. . . . . . . . . . . . . . . . . . . . . .
TV Shows . . . . . . . . . . . . . . . . . . .
Radio. . . . . . . . . . . . . . . . . . . . . . .
Newspapers . . . . . . . . . . . . . . . . .
Magazines. . . . . . . . . . . . . . . . . . .
Internet . . . . . . . . . . . . . . . . . . . . .
Music. . . . . . . . . . . . . . . . . . . . . . .
Other Entertainment . . . . . . . . . . .
News . . . . . . . . . . . . . . . . . . . . . . .
Politics. . . . . . . . . . . . . . . . . . . . . .
Sports . . . . . . . . . . . . . . . . . . . . . .
Sporting Equipment . . . . . . . . . . .
Fishing . . . . . . . . . . . . . . . . . . . . .
Hunting . . . . . . . . . . . . . . . . . . . . .
Parenting. . . . . . . . . . . . . . . . . . . .
Education . . . . . . . . . . . . . . . . . . .
Products for Babies
or Children . . . . . . . . . . . . . . . . .
Pets . . . . . . . . . . . . . . . . . . . . . . . .
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
1
2
3
4
Family Members . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Friends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Colleagues or people you know through work . . . . . . . . .
Neighbors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
People who share a hobby or interest of yours. . . . . . . . .
People you know through a community group or
other activity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
People you know through your kids’ activities. . . . . . . . . .
People you don’t necessarily know, but ran into at a
store or point of sale . . . . . . . . . . . . . . . . . . . . . . . . . . .
People you don’t necessarily know, but have made a
recommendation to online (e.g. via chat room, online
bulletin board, etc.) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
2
3
4
5
6
7
8
9
F. For each of the following categories, which, if any, of these
people have you recommended any product or service to
in the past 12 months?
62L
Family/
Friends
Automotive . . . . .
Finance . . . . . . .
Technology. . . . .
Food. . . . . . . . . .
Vacation Travel . .
Healthcare . . . . .
Neighbors/
Colleagues
1
2
People you Don’t
Necessarily Know
(in stores, online, etc.)
3
01
02
03
04
05
06
ACTIVITIES
69P
About how many hours per week do you typically spend
at each of these activities? If none, please mark “0”:
Number of hours/
week
With kids or grandkids at home
or outside the home . . . . . . . . . . . . . . . . . . . . .
With your spouse or significant other . . . . . . . . .
Watching television or movies at home. . . . . . . .
At your personal computer,
including the Internet . . . . . . . . . . . . . . . . . . . .
Reading. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Doing fun and exciting things . . . . . . . . . . . . . . .
Learning new things or expanding
your knowledge . . . . . . . . . . . . . . . . . . . . . . . .
Gardening or yard work. . . . . . . . . . . . . . . . . . . .
Housework (cleaning, washing, etc.) . . . . . . . . .
Cooking. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Working on your automobile . . . . . . . . . . . . . . . .
Alone. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Commuting to and from work . . . . . . . . . . . . . . .
At schools or any organizations
other than church . . . . . . . . . . . . . . . . . . . . . . .
Socializing/doing things with friends
around town . . . . . . . . . . . . . . . . . . . . . . . . . . .
Working at a paid job outside of home . . . . . . . .
Working at a paid job at home . . . . . . . . . . . . . .
Exercising . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
Number of hours/
night
On average, about how many hours of sleep
do you get each night? . . . . . . . . . . . . . . . . . . . .
19
Page 87
The remainder of this questionnaire refers to products used by or for
the entire household.
It should be completed by the person who does most
of the shopping for groceries and household items, and who is:
First Name
Last Name
For each product bought by you for household use:
Place an “X” in the top “TOTAL” box if you have used the product in
the last 6 months, and then place “X’s” in the boxes for each type,
brand, etc. you have used.
Then write on the top line the total amount of the product you have
used in the specified time period and write in below the amount of
each type, brand, etc. you used.
Please read the full INSTRUCTIONS at the beginning of the booklet
carefully, before starting to answer the questions.
FOOD
Page 88
BREAD
Your Household:
Used in
Loaves/
last 6
last 7
months
days
ENGLISH MUFFINS
710
TOTAL:
................. Italian . . . . . . . . . . . . . . . . . .
Multi-grain. . . . . . . . . . . . . . .
Oat . . . . . . . . . . . . . . . . . . . .
Pita . . . . . . . . . . . . . . . . . . . .
Potato . . . . . . . . . . . . . . . . . .
Pumpernickel . . . . . . . . . . . .
Raisin . . . . . . . . . . . . . . . . . .
Rye . . . . . . . . . . . . . . . . . . . .
Sourdough . . . . . . . . . . . . . .
Wheat . . . . . . . . . . . . . . . . . .
White . . . . . . . . . . . . . . . . . . Other . . . . . . . . . . . . . . . . . . KINDS:
Reduced Calorie/Light . . . . . Regular. . . . . . . . . . . . . . . . . BRANDS:
Arnold. . . . . . . . . . . . . . . . . .
Aunt Millie’s. . . . . . . . . . . . . .
Beefsteak . . . . . . . . . . . . . . .
Bimbo . . . . . . . . . . . . . . . . .
Brownberry. . . . . . . . . . . . . .
Bunny . . . . . . . . . . . . . . . . . .
Butternut. . . . . . . . . . . . . . . .
Colonial . . . . . . . . . . . . . . . .
Country Hearth. . . . . . . . . . .
Dave’s Killer Bread . . . . . . . .
D’Italiano . . . . . . . . . . . . . . .
EarthGrains . . . . . . . . . . . . .
Flatout . . . . . . . . . . . . . . . . .
Francisco . . . . . . . . . . . . . . .
Freihofer’s. . . . . . . . . . . . . . .
Merita . . . . . . . . . . . . . . . . . .
Mrs Baird’s . . . . . . . . . . . . . .
Nature’s Harvest. . . . . . . . . .
Nature’s Own . . . . . . . . . . . .
Nature’s Pride . . . . . . . . . . . .
Oroweat . . . . . . . . . . . . . . . .
Pepperidge Farm . . . . . . . . .
Roman Meal . . . . . . . . . . . . .
Sahara . . . . . . . . . . . . . . . . .
Sara Lee Delightful. . . . . . . .
Sara Lee Soft & Smooth. . . .
Other Sara Lee. . . . . . . . . . .
Stroehmann . . . . . . . . . . . . .
Sunbeam . . . . . . . . . . . . . . .
Sun-Maid Raisin Bread . . . .
Wonder . . . . . . . . . . . . . . . . .
Store’s Own Brand
(Packaged) . . . . . . . . . . . .
Store’s Own Bakery Style. . .
OTHER (Write In)
REFRIGERATED/
FROZEN BREAD AND
DOUGH PRODUCTS
711
TYPES:
Bran . . . . . . . . . . . . . . . . . . .
Cinnamon. . . . . . . . . . . . . . .
Egg. . . . . . . . . . . . . . . . . . . .
French . . . . . . . . . . . . . . . . .
Garlic . . . . . . . . . . . . . . . . . .
Holsum . . . . . . . . . . . . . . . . .
Home Pride . . . . . . . . . . . . .
Iron Kids . . . . . . . . . . . . . . . .
King’s Hawaiian . . . . . . . . . .
Maier’s . . . . . . . . . . . . . . . . .
Your Household:
Used in
Number/
last 6
last 7
months
days
715
................. 00
TOTAL:
01
TYPES:
Pre-Sliced . . . . . . . . . . . . . . . Other . . . . . . . . . . . . . . . . . . 02
03
04
05
06
07
08
09
10
11
12
BRANDS:
Bays . . . . . . . . . . . . . . . . . . .
Crystal Farms . . . . . . . . . . . .
Oroweat . . . . . . . . . . . . . . . .
Sun-Maid Raisin. . . . . . . . . .
14
15
BAGELS
17
20
21
22
23
24
25
26
................. BRANDS:
Bagel-fuls . . . . . . . . . . . . . . .
Lender’s Bagels . . . . . . . . . .
Lender’s New York Style. . . .
Sara Lee Bagels. . . . . . . . . .
Thomas’ Bagels . . . . . . . . . .
Thomas’ Bagel Thins . . . . . .
Thomas’ Mini Bagels . . . . . .
31
PIZZA
SHELLS/CRUSTS
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
999
04
05
06
07
08
09
999
00
01
02
03
04
05
06
07
08
09
999
OTHER (Write In)
29
30
03
Your Household:
Used in
Packages/
last 6
last 30
months
days
27
28
01
02
712
TOTAL:
19
00
OTHER (Write In)
16
18
Thomas’ . . . . . . . . . . . . . . . . Store’s Own Brand . . . . . . . . 13
Your Household:
Used in
Packages/
last 6
last 30
months
days
713
TOTAL:
................. TYPES:
Fresh . . . . . . . . . . . . . . . . . . Refrigerated . . . . . . . . . . . . . Frozen . . . . . . . . . . . . . . . . . BRANDS:
Betty Crocker . . . . . . . . . . . .
Boboli Pizza Crust . . . . . . . .
Jiffy Pizza Crust Mix . . . . . . .
Mama Mary’s . . . . . . . . . . . .
MaMa Rosa’s . . . . . . . . . . . .
Pillsbury Pizza Crust . . . . . . Store’s Own Brand . . . . . . . . OTHER (Write In)
Your Household:
Used in
Packages/
last 6
last 30
months
days
00
TOTAL:
................. TYPES:
Biscuits. . . . . . . . . . . . . . . . .
Breads (Not Garlic) . . . . . . .
Brownies. . . . . . . . . . . . . . . .
Cookies . . . . . . . . . . . . . . . .
Croissants . . . . . . . . . . . . . .
Dinner Rolls . . . . . . . . . . . . . Garlic Bread . . . . . . . . . . . . . Sweet Rolls . . . . . . . . . . . . . BRANDS:
Cole’s . . . . . . . . . . . . . . . . . .
Nestlé Toll House Refrigerated
Cookie Dough . . . . . . . . . .
New York Brand Texas Toast. .
Pepperidge Farm Garlic
Bread . . . . . . . . . . . . . . . .
Pepperidge Farm Puff
Pastry . . . . . . . . . . . . . . .
00
01
02
03
04
05
06
07
08
09
10
11
12
13
Other Pepperidge Farm . . . .
Pillsbury Cinnamon Rolls
with Icing. . . . . . . . . . . . . .
Pillsbury Cookie Dough . . . .
Pillsbury Crescent Rolls . . . .
Pillsbury Crusty French Loaf
14
Pillsbury Grands! Biscuits . .
Pillsbury Ready to Bake! . . .
Pillsbury Breadsticks . . . . . .
Other Pillsbury Biscuits . . . .
Other Pillsbury Dinner Rolls .
Other Pillsbury Sweet Rolls .
Rhodes Frozen Bread
Dough . . . . . . . . . . . . . . . .
Rhodes Frozen Roll Dough .
Sara Lee Cinnamon Rolls . .
Sara Lee Croissants. . . . . . .
Sister Schubert’s . . . . . . . . . Store’s Own Brand . . . . . . . . 15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
999
OTHER (Write In)
01
02
03
OTHER BREAD
PRODUCTS
Your Household:
Used in
Packages/
last 6
last 30
months
days
716
04
................. 05
TOTAL:
06
TYPES:
Biscuits. . . . . . . . . . . . . . . . .
Breadsticks. . . . . . . . . . . . . .
Croissants/Crescent Rolls . .
Dinner Rolls . . . . . . . . . . . . .
Garlic Bread . . . . . . . . . . . . .
Hamburger Rolls/Buns . . . . .
Hot Dog Rolls/Buns . . . . . . .
Kaiser Rolls . . . . . . . . . . . . .
Parkerhouse Rolls . . . . . . . .
Sandwich Thin/Flat Rolls . . .
07
08
09
10
999
Scones . . . . . . . . . . . . . . . . . OTHER (Write In)
00
01
02
03
04
05
06
07
08
09
10
11
999
FOOD
Page 89
Your Household:
Used in
Containers/
last 6
last 6
months
months
SALT
MARGARINE
................. BRANDS:
Diamond Crystal (Regular) . .
Diamond Crystal Salt
Sense . . . . . . . . . . . . . . . .
Hain . . . . . . . . . . . . . . . . . . .
McCormick . . . . . . . . . . . . . .
Morton . . . . . . . . . . . . . . . . .
00
01
02
03
04
05
Morton Lite Salt . . . . . . . . . . Generic (No Label). . . . . . . . Store’s Own Brand . . . . . . . . 06
07
08
999
OTHER (Write In)
SALT
ALTERNATIVES
Your Household:
Used in
Containers/
last 6
last 6
months
months
718
TOTAL:
................. BRANDS:
Lawry’s . . . . . . . . . . . . . . . . .
McCormick . . . . . . . . . . . . . .
Morton Salt Substitute . . . . .
Other Morton . . . . . . . . . . . .
Mrs. Dash . . . . . . . . . . . . . . .
00
01
02
03
04
05
NoSalt. . . . . . . . . . . . . . . . . . 06
999
OTHER (Write In)
SUGAR
Your Household:
Used in
Pounds/
last 6
last 30
months
days
719
TOTAL:
................. TYPES:
Cubes. . . . . . . . . . . . . . . . . .
Dark Brown. . . . . . . . . . . . . .
Light Brown . . . . . . . . . . . . .
Confectioners . . . . . . . . . . . .
Corn Syrup . . . . . . . . . . . . . .
00
01
02
03
04
05
White Granulated . . . . . . . . . Turbinado . . . . . . . . . . . . . . . 06
07
BRANDS:
C&H . . . . . . . . . . . . . . . . . . .
Crystal . . . . . . . . . . . . . . . . .
Dixie Crystals . . . . . . . . . . . .
Domino. . . . . . . . . . . . . . . . .
Florida Crystals . . . . . . . . . .
08
09
10
11
12
GW . . . . . . . . . . . . . . . . . . . .
Imperial . . . . . . . . . . . . . . . .
Sugar In The Raw. . . . . . . . .
13
14
15
16
17
999
OTHER (Write In)
YEAST
Your Household:
Used in
Packs/
last 6
last 30
months
days
................. BRANDS:
Fleischmann’s. . . . . . . . . . . . Red Star . . . . . . . . . . . . . . . . OTHER (Write In)
TOTAL:
................. TYPES:
Butter Blend . . . . . . . . . . . . .
Canola Oil. . . . . . . . . . . . . . .
Corn Oil (100%) . . . . . . . . . .
Olive Oil . . . . . . . . . . . . . . . .
Safflower/Sunflower (100%)
00
01
02
03
04
05
Soybean Oil . . . . . . . . . . . . . Other Vegetable Oil . . . . . . . 06
07
KINDS:
Sticks . . . . . . . . . . . . . . . . . .
Bowls/Tubs . . . . . . . . . . . . . .
Spray . . . . . . . . . . . . . . . . . .
Squeeze . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . .
BRANDS:
Blue Bonnet Light. . . . . . . . .
Blue Bonnet (Regular) . . . . .
Brummel & Brown . . . . . . . .
Country Crock—
Churn Style. . . . . . . . . . . .
Country Crock Spreadable
Sticks . . . . . . . . . . . . . . . .
Country Crock Light . . . . . . .
Country Crock (Regular) . . .
Other Country Crock . . . . . .
Fleischmann’s. . . . . . . . . . . .
I Can’t Believe It’s Not Butter!
Light . . . . . . . . . . . . . . . . .
(Regular). . . . . . . . . . . . . .
Imperial . . . . . . . . . . . . . . . .
Land O’Lakes Fresh Buttery
Taste . . . . . . . . . . . . . . . . .
Land O’Lakes (Regular) . . . .
Olivio Spread . . . . . . . . . . . .
Parkay Light . . . . . . . . . . . . .
Parkay (Regular) . . . . . . . . .
Parkay Spread (Regular) . . .
Promise Light . . . . . . . . . . . .
Promise (Regular) . . . . . . . .
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
00
01
02
999
28
01
02
BRANDS:
All Whites . . . . . . . . . . . . . . .
Better’n Eggs . . . . . . . . . . . .
Egg Beaters . . . . . . . . . . . . .
03
04
05
06
999
OTHER (Write In)
BUTTER
TOTAL:
Your Household:
Used in
Pounds/
last 6
last 30
months
days
................. BRANDS:
Breakstone’s . . . . . . . . . . . . .
Challenge . . . . . . . . . . . . . . .
Country Crock Spreadable
Butter . . . . . . . . . . . . . . . .
Crystal Farms . . . . . . . . . . . .
Darigold . . . . . . . . . . . . . . . .
Hotel Bar . . . . . . . . . . . . . . .
Keller’s . . . . . . . . . . . . . . . . .
Kerrygold . . . . . . . . . . . . . . .
Land O’Lakes Light . . . . . . .
Land O’Lakes (Regular) . . . .
Land O’Lakes Spreadable
Butter with Canola Oil . . . .
Organic Valley. . . . . . . . . . . .
Smart Balance Butter &
Canola Blend . . . . . . . . . .
Tillamook . . . . . . . . . . . . . . .
30
31
FLOUR/
CORNMEAL
32
Your Household:
Used in
Dozens/
last 6
last 30
months
days
................. 00
TYPES:
Organic. . . . . . . . . . . . . . . . . Regular. . . . . . . . . . . . . . . . . 01
02
999
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
999
Your Household:
Used in
Pounds/
last 6
last 30
months
days
728
33
34
999
00
OTHER (Write In)
29
Used for:
723-0
Baking . . . . . . . . . . . . . . . . . 1
Cooking . . . . . . . . . . . . . . . . 2
Table spread . . . . . . . . . . . . . 3
OTHER (Write In)
00
27
OTHER (Write In)
TOTAL:
................. TYPES:
Refrigerated . . . . . . . . . . . . . Frozen . . . . . . . . . . . . . . . . . TOTAL:
726
Smart Balance . . . . . . . . . . . Store’s Own Brand . . . . . . . . EGGS
Your Household:
Used in
Packages/
last 6
last 30
months
days
725
724
720
TOTAL:
EGG ALTERNATIVES
722
717
TOTAL:
Your Household:
Used in
Pounds/
last 6
last 30
months
days
TOTAL:
................. TYPES:
All Purpose/White Flour . . . .
Unbleached Flour . . . . . . . . .
Whole Wheat Flour . . . . . . . .
Cornmeal . . . . . . . . . . . . . . .
00
01
02
03
04
KINDS:
Bread/Pastry. . . . . . . . . . . . . Self-Rising . . . . . . . . . . . . . . 05
06
BRANDS:
Aunt Jemima. . . . . . . . . . . . .
Bob’s Red Mill. . . . . . . . . . . .
Gold Medal. . . . . . . . . . . . . .
Hodgson Mill . . . . . . . . . . . .
King Arthur . . . . . . . . . . . . . .
07
08
09
10
11
Martha White . . . . . . . . . . . .
Maseca. . . . . . . . . . . . . . . . .
Pillsbury Best . . . . . . . . . . . .
Quaker . . . . . . . . . . . . . . . . .
White Lily . . . . . . . . . . . . . . .
12
13
14
15
16
Wondra . . . . . . . . . . . . . . . . . Store’s Own Brand . . . . . . . . OTHER (Write In)
17
18
999
FOOD
Page 90
SPRAY NON-STICK
COOKING PRODUCTS
Your Household:
Used in
Cans/
last 6
last 6
months
months
FRESH MILK
................. BRANDS:
Baker’s Joy . . . . . . . . . . . . . .
Crisco Butter Flavored . . . . .
Crisco Regular (Original) . . .
Mazola . . . . . . . . . . . . . . . . .
Pam Baking . . . . . . . . . . . . .
Pam Butter Flavor. . . . . . . . .
Pam Grilling . . . . . . . . . . . . .
Pam Olive Oil . . . . . . . . . . . .
Pam Regular (Original) . . . .
OTHER (Write In)
BAKING POWDER
AND SODA
00
01
02
03
04
05
06
07
08
09
10
999
Your Household:
Used in
Packages/
last 6
last 30
months
days
730
TOTAL:
................. 00
TYPES:
Powder . . . . . . . . . . . . . . . . . Soda. . . . . . . . . . . . . . . . . . . BRANDS:
Argo . . . . . . . . . . . . . . . . . . .
Arm & Hammer. . . . . . . . . . .
Calumet . . . . . . . . . . . . . . . .
Clabber Girl . . . . . . . . . . . . .
Davis . . . . . . . . . . . . . . . . . .
01
02
Rumford . . . . . . . . . . . . . . . . 03
BRANDS:
Crisco Regular . . . . . . . . . . . Crisco Butter Flavor . . . . . . . Store’s Own Brand . . . . . . . . 07
08
999
00
01
02
03
999
Your Household:
Used in
Containers/
last 6
last 30
months
days
04
01
03
05
06
07
08
09
10
11
12
13
14
15
999
OTHER (Write In)
Your Household:
Used in
Cans/
last 6
last 30
months
days
736
TOTAL:
................. TYPES:
Low Fat. . . . . . . . . . . . . . . . . Regular. . . . . . . . . . . . . . . . . Skim . . . . . . . . . . . . . . . . . . . BRANDS:
Carnation . . . . . . . . . . . . . . .
Eagle Brand (Borden). . . . . .
Nestlé La Lechera . . . . . . . .
Pet . . . . . . . . . . . . . . . . . . . .
NON-DAIRY CREAM
SUBSTITUTES
00
01
02
03
04
05
06
07
08
09
10
999
Your Household:
Used in
Servings/
last 6
average
months
day
TOTAL:
TYPES:
Regular. . . . . . . . . . . . . . . . . Low Fat. . . . . . . . . . . . . . . . . Non-Fat/Fat Free . . . . . . . . . BRANDS:
Axelrod . . . . . . . . . . . . . . . . .
Breakstone’s . . . . . . . . . . . . .
Breakstone’s Reduced Fat . .
Daisy . . . . . . . . . . . . . . . . . .
Dean’s . . . . . . . . . . . . . . . . .
Friendship. . . . . . . . . . . . . . .
Hood. . . . . . . . . . . . . . . . . . .
Kemps . . . . . . . . . . . . . . . . .
Knudsen . . . . . . . . . . . . . . . .
Land O’Lakes . . . . . . . . . . . .
Simply Kraft . . . . . . . . . . . . . Store’s Own Brand . . . . . . . . 00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
999
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Liquid or Frozen . . . . . . . . . .
Powder . . . . . . . . . . . . . . . . .
BRANDS:
Borden Cremora. . . . . . . . . .
Coffee Rich. . . . . . . . . . . . . .
Dunkin’ Donuts . . . . . . . . . . .
International Delight . . . . . . .
Nestlé Coffee-Mate Liquid . .
TYPES:
Organic. . . . . . . . . . . . . . . . . Non-organic . . . . . . . . . . . . . KINDS:
Low Fat. . . . . . . . . . . . . . . . . Non Fat/Fat Free . . . . . . . . . Regular. . . . . . . . . . . . . . . . . BRANDS:
Chobani . . . . . . . . . . . . . . . .
DanActive . . . . . . . . . . . . . . .
Dannon Activia . . . . . . . . . . .
Dannon Activia Greek. . . . . .
Dannon All Natural . . . . . . . .
Dannon Danimals. . . . . . . . .
Dannon Fruit on the Bottom
Dannon Light & Fit . . . . . . . .
Dannon Light & Fit Greek . . .
Fage . . . . . . . . . . . . . . . . . . .
Horizon Organic . . . . . . . . . .
La Yogurt . . . . . . . . . . . . . . .
Mountain High . . . . . . . . . . .
Müller . . . . . . . . . . . . . . . . . .
Oikos (Dannon) . . . . . . . . . .
Stonyfield . . . . . . . . . . . . . . .
Stonyfield Greek . . . . . . . . . .
Trix . . . . . . . . . . . . . . . . . . . .
Voskos . . . . . . . . . . . . . . . . .
Yo Crunch . . . . . . . . . . . . . . .
Yoplait Go-Gurt . . . . . . . . . . .
Yoplait Greek . . . . . . . . . . . .
Yoplait Light . . . . . . . . . . . . .
Yoplait Original . . . . . . . . . . .
Yoplait Thick & Creamy . . . .
Yoplait Whips! . . . . . . . . . . . . Store’s Own Brand . . . . . . . . 00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
999
OTHER (Write In)
FROZEN YOGURT
Your Household:
Used in
Pints/
last 6
last 7
months
days
739
Nestlé Coffee-Mate Powder . Store’s Own Brand . . . . . . . . OTHER (Write In)
................. FORMS:
With Fruit—premixed . . . . . .
With Fruit—not premixed . . .
Other Flavor . . . . . . . . . . . . .
Plain (Unflavored). . . . . . . . .
737
................. OTHER (Write In)
2% Low Fat . . . . . . . . . . . . . Buttermilk . . . . . . . . . . . . . . . Half & Half . . . . . . . . . . . . . . OTHER (Write In)
733
TOTAL:
02
KINDS:
Condensed . . . . . . . . . . . . . . Evaporated . . . . . . . . . . . . . . OTHER (Write In)
SOUR CREAM
KINDS:
Chocolate Milk Low Fat . . . .
Chocolate Milk Regular . . . .
Whole Milk . . . . . . . . . . . . . .
Skim . . . . . . . . . . . . . . . . . . .
1% Low Fat . . . . . . . . . . . . .
00
TYPES:
Organic. . . . . . . . . . . . . . . . . Calcium Added/Vitamin
Fortified. . . . . . . . . . . . . . . Lactose Reduced . . . . . . . . . 06
Your Household:
Used in
Pounds/
last 6
last 30
months
days
................. ................. EVAPORATED/
CONDENSED MILK
Your Household:
Used in
Containers/
last 6
last 7
months
days
738
FORMS:
Glass Bottle . . . . . . . . . . . . .
Paperboard Carton. . . . . . . .
Plastic Jug . . . . . . . . . . . . . .
Aseptic (Shelf Stable)
Carton. . . . . . . . . . . . . . . .
05
731
TOTAL:
TOTAL:
04
OTHER (Write In)
SHORTENING
YOGURT
734
729
TOTAL:
Your Household:
Used in
Quarts/
last 6
last 7
months
days
00
01
02
03
04
05
06
07
08
09
999
TOTAL:
................. TYPES:
Ben & Jerry’s . . . . . . . . . . . .
Blue Bunny . . . . . . . . . . . . . .
Dreyer’s . . . . . . . . . . . . . . . .
Edy’s. . . . . . . . . . . . . . . . . . .
Häagen-Dazs . . . . . . . . . . . .
Healthy Choice Greek . . . . .
Kemps . . . . . . . . . . . . . . . . .
Oikos (Dannon) . . . . . . . . . .
Turkey Hill . . . . . . . . . . . . . . .
Yoplait . . . . . . . . . . . . . . . . . .
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
999
FOOD
Page 91
ICE CREAM,
GELATO
& SHERBET
Your Household:
Used in
Pints/
last 6
last 7
months
days
ICE CREAM BARS,
SANDWICHES &
BON BONS
................. TYPES:
Fat Free . . . . . . . . . . . . . . . .
Light Ice Cream . . . . . . . . .
Regular Ice Cream . . . . . . . .
No Sugar Added Ice Cream
Gelato. . . . . . . . . . . . . . . . . .
00
01
02
03
04
05
Sherbet. . . . . . . . . . . . . . . . . Fruit Sorbet. . . . . . . . . . . . . . BRANDS:
Ben & Jerry’s . . . . . . . . . . . .
Blue Bell . . . . . . . . . . . . . . . .
Blue Bunny . . . . . . . . . . . . . .
Breyers . . . . . . . . . . . . . . . . .
Country Rich . . . . . . . . . . . .
Dean’s . . . . . . . . . . . . . . . . .
Dove . . . . . . . . . . . . . . . . . . .
Dreyer’s Grand . . . . . . . . . . .
Dreyer’s Slow Churned. . . . .
Edy’s Grand . . . . . . . . . . . . .
Edy’s Slow Churned . . . . . . .
Friendly’s . . . . . . . . . . . . . . .
Häagen-Dazs . . . . . . . . . . . .
Kemps . . . . . . . . . . . . . . . . .
Mayfield . . . . . . . . . . . . . . . .
Tillamook . . . . . . . . . . . . . . . Turkey Hill . . . . . . . . . . . . . . . Store’s Own Brand . . . . . . . . 06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
999
OTHER (Write In)
WHIPPED TOPPING
Your Household:
Used in
Containers/
last 12
last 12
months
months
743
TOTAL:
................. BRANDS:
Cool Whip . . . . . . . . . . . . . .
Cool Whip Extra Creamy . . .
Cool Whip Free. . . . . . . . . . .
Cool Whip Lite . . . . . . . . . . .
Cool Whip Sugar Free . . . . .
Dean’s Whipping Cream . . . .
Dream Whip . . . . . . . . . . . . .
Reddi-wip Original . . . . . . . .
Reddi-wip Extra Creamy. . . .
Reddi-wip Fat Free . . . . . . . .
Other Reddi-wip . . . . . . . . . . Store’s Own Brand . . . . . . . . TOTAL:
01
02
03
04
05
06
07
08
09
10
11
12
13
14
999
OTHER (Write In)
................. BRANDS:
Ben & Jerry’s . . . . . . . . . . . .
Blue Bunny . . . . . . . . . . . . . .
Breyers . . . . . . . . . . . . . . . . .
Creamsicle . . . . . . . . . . . . . .
Dean’s . . . . . . . . . . . . . . . . .
Dove Bar . . . . . . . . . . . . . . .
Eskimo Pie . . . . . . . . . . . . . .
Friendly’s . . . . . . . . . . . . . . .
Good Humor Bar . . . . . . . . .
Häagen-Dazs Bar. . . . . . . . .
Klondike Bars . . . . . . . . . . . .
Klondike 100 Calorie . . . . . .
M & M’s . . . . . . . . . . . . . . . .
Magnum . . . . . . . . . . . . . . . .
Milky Way Ice Cream Bar . . .
Nestlé Crunch Bar . . . . . . . .
Nestlé Dibs. . . . . . . . . . . . . .
Nestlé Drumstick Cones. . . .
Nestlé Pops . . . . . . . . . . . . .
Skinny Cow . . . . . . . . . . . . .
Snickers Ice Cream Bar . . . .
Weight Watchers Bars . . . . .
Weight Watchers
Sandwiches . . . . . . . . . . .
OTHER (Write In)
01
02
03
04
05
07
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
999
00
01
02
03
04
05
Fruttare . . . . . . . . . . . . . . . . .
Fudgsicle . . . . . . . . . . . . . . .
Fudgsicle—No Sugar Added .
Luigi’s . . . . . . . . . . . . . . . . . .
Minute Maid . . . . . . . . . . . . .
06
07
08
09
10
Pop-Ice . . . . . . . . . . . . . . . . .
Popsicle Ice Pops . . . . . . . . .
Popsicle—Sugar Free. . . . . .
Push-Up . . . . . . . . . . . . . . . .
11
12
13
14
15
999
Your Household:
Used in
Jars/
last 12
Containers
months last 12 months
744
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Hershey’s . . . . . . . . . . . . . . .
Mrs. Richardson’s . . . . . . . . .
Nestlé Nesquik . . . . . . . . . . .
Smucker’s. . . . . . . . . . . . . . .
06
999
BRANDS:
Del Monte Fruit Chillers . . . .
Dreyer’s Outshine Fruit Bars
Edy’s Outshine Fruit Bars. . .
Fla • Vor • Ice . . . . . . . . . . . .
FrozFruit . . . . . . . . . . . . . . . .
DESSERT TOPPINGS
00
01
02
03
04
................. 852
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Shelled . . . . . . . . . . . . . . . . .
Unshelled . . . . . . . . . . . . . . .
BRANDS:
Blue Diamond Almonds . . . .
Diamond. . . . . . . . . . . . . . . .
Fisher . . . . . . . . . . . . . . . . . .
Planters . . . . . . . . . . . . . . . .
BRANDS:
Banquet Pies . . . . . . . . . . . .
Bertolli . . . . . . . . . . . . . . . . .
Edwards Pies . . . . . . . . . . . .
Eli’s Cheesecake . . . . . . . . .
Marie Callender’s Pies . . . . .
Your Household:
Used in
Packages/
last 6
last 30
months
days
OTHER (Write In)
Your Household:
Used in
Pounds/
last 6
last 30
months
days
TOTAL:
741
TOTAL:
OTHER (Write In)
................. 00
OTHER (Write In)
FROZEN SNACKS
(Not Frozen Yogurt
or Ice Cream)
Your Household:
Used in
Packages/
last 6
last 30
months
days
745
TYPES:
Bars . . . . . . . . . . . . . . . . . . .
Bon Bons . . . . . . . . . . . . . . .
Cones . . . . . . . . . . . . . . . . . .
Sandwiches . . . . . . . . . . . . .
00
TYPES:
Aerosol . . . . . . . . . . . . . . . . . Frozen/Refrigerated . . . . . . . NUTS FOR COOKING
FROZEN DESSERTS
742
740
TOTAL:
Your Household:
Used in
Packages/
last 6
last 30
months
days
00
01
02
03
04
05
999
00
Mrs. Smith’s Cobblers . . . . . .
Mrs. Smith’s (Other Pies) . . .
Pepperidge Farm 3-Layer
Cake . . . . . . . . . . . . . . . . .
Pepperidge Farm Turnovers .
Pepperidge Farm (Other
Desserts) . . . . . . . . . . . . .
Sara Lee Cheesecake . . . . .
Sara Lee Coffee Cake . . . . .
Sara Lee Pies. . . . . . . . . . . .
Sara Lee Pound Cake . . . . .
Sara Lee (Other Desserts) . .
01
02
03
04
05
06
07
08
09
Weight Watchers Smart
Ones . . . . . . . . . . . . . . . . . Store’s Own Brand . . . . . . . . 10
11
12
13
14
15
16
17
999
OTHER (Write In)
BAR BAKING
CHOCOLATE
Your Household:
Used in
Boxes/
last 6
last 30
months
days
747
TOTAL:
................. TYPES:
Unsweetened . . . . . . . . . . . .
Bittersweet . . . . . . . . . . . . . .
Semi-Sweet . . . . . . . . . . . . .
German Sweet . . . . . . . . . . .
White Chocolate . . . . . . . . . .
BRANDS:
Baker’s . . . . . . . . . . . . . . . . .
Ghirardelli . . . . . . . . . . . . . . .
Hershey’s . . . . . . . . . . . . . . .
Nestlé . . . . . . . . . . . . . . . . . .
OTHER (Write In)
00
01
02
03
04
05
06
07
08
09
999
FOOD
Page 92
BAKING CHIPS
Your Household:
Used in
Bags/
last 6
last 30
months
days
BAKING MIXES
(Excluding cake
mixes)
751
748
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Butterscotch . . . . . . . . . . . . .
Peanut Butter . . . . . . . . . . . .
Milk Chocolate . . . . . . . . . . .
Semi-Sweet Chocolate. . . . .
White Chocolate . . . . . . . . . .
KINDS:
Mini. . . . . . . . . . . . . . . . . . . .
Regular. . . . . . . . . . . . . . . . .
Chunks . . . . . . . . . . . . . . . . .
BRANDS:
Baker’s Chunks . . . . . . . . . .
Ghirardelli . . . . . . . . . . . . . . .
Hershey’s . . . . . . . . . . . . . . .
M & M’s Mini Baking Bits . . .
Nestlé Toll House . . . . . . . . .
Reese’s. . . . . . . . . . . . . . . . .
OTHER (Write In)
BAKING COCONUT
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
999
Your Household:
Used in
Containers/
last 6
last 30
months
days
Duncan Hines
Simple Mornings
Blueberry Muffins . . . . . . .
Other Duncan Hines
Simple Mornings Muffins. .
Fleischmann’s Simply
Homemade . . . . . . . . . . . .
Jiffy . . . . . . . . . . . . . . . . . . . .
Krusteaz . . . . . . . . . . . . . . . .
Martha White Cornbread . . .
Martha White Muffins . . . . . .
Pillsbury Muffin Mix . . . . . . .
Pillsbury Quick Bread . . . . . .
OTHER (Write In)
DRY CAKE MIXES
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Baker’s . . . . . . . . . . . . . . . . .
Mounds . . . . . . . . . . . . . . . .
OTHER (Write In)
00
01
02
03
999
Your Household:
Used in
Packages/
last 6
last 30
months
days
750
TOTAL:
................. TYPES:
Decorating icings . . . . . . . . .
Ready to spread . . . . . . . . . .
Package frosting mix . . . . . .
BRANDS:
Betty Crocker Rich &
Creamy . . . . . . . . . . . . . . .
Betty Crocker Whipped . . . .
Duncan Hines Creamy
Home-Style . . . . . . . . . . .
Duncan Hines Whipped . . . .
Jiffy Frosting Mix. . . . . . . . . .
Pillsbury Creamy Supreme. .
Pillsbury Funfetti . . . . . . . . . .
OTHER (Write In)
EXTRACTS
01
02
03
04
05
06
07
08
09
10
11
999
Your Household:
Used in
Bottles/
last 6
last 6
months
months
848
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Durkee . . . . . . . . . . . . . . . . .
McCormick . . . . . . . . . . . . . .
Tone’s . . . . . . . . . . . . . . . . . .
Watkins. . . . . . . . . . . . . . . . .
OTHER (Write In)
00
00
01
02
03
04
05
06
999
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
999
Your Household:
Used in
Packages/
last 6
last 30
months
days
752
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Betty Crocker Angel Food. . .
Betty Crocker Pound Cake . .
Betty Crocker Super Moist . .
Betty Crocker Warm Delights
Duncan Hines Angel Food . .
Duncan Hines Classic Mixes
Other Duncan Hines Cake . .
Jell-O No Bake Cheesecake
Jiffy . . . . . . . . . . . . . . . . . . . .
Pillsbury Funfetti . . . . . . . . . .
Pillsbury Moist Supreme. . . . Pillsbury Sugar Free . . . . . . . Store’s Own Brand . . . . . . . . 00
01
02
03
04
05
06
07
08
09
10
11
12
13
999
Your Household:
Packages or
Used in
containers/
last 6
last 6
months
months
847
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Accent. . . . . . . . . . . . . . . . . .
Adolph’s . . . . . . . . . . . . . . . .
Badia . . . . . . . . . . . . . . . . . .
Durkee . . . . . . . . . . . . . . . . .
Goya Adobo . . . . . . . . . . . . .
Other Goya Spices . . . . . . . .
Herb-Ox . . . . . . . . . . . . . . . .
Hidden Valley . . . . . . . . . . . .
Kitchen Bouquet. . . . . . . . . .
Lawry’s . . . . . . . . . . . . . . . . .
McCormick . . . . . . . . . . . . . .
Morton . . . . . . . . . . . . . . . . .
Mrs. Dash . . . . . . . . . . . . . . .
Spice Classics . . . . . . . . . . .
Spice Islands . . . . . . . . . . . .
Spice World . . . . . . . . . . . . .
Tone’s . . . . . . . . . . . . . . . . . .
Weber . . . . . . . . . . . . . . . . . .
Wyler’s . . . . . . . . . . . . . . . . .
OTHER (Write In)
Your Household:
Used in
Packages/
last 6
last 30
months
days
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Betty Crocker Cookie Mix . . .
Betty Crocker Brownies . . . .
Duncan Hines Brownies . . . .
Other Duncan Hines. . . . . . .
Ghirardelli Brownies . . . . . . .
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
999
00
01
02
03
04
05
Pillsbury Cookie Mix. . . . . . . Pillsbury Brownies . . . . . . . . Store’s Own Brand . . . . . . . . 06
07
08
999
OTHER (Write In)
PACKAGED PIE
CRUST
Your Household:
Used in
Boxes or
last 6
packs/last
months
30 days
755
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Graham Cracker Crumbs . . .
Frozen Pastry . . . . . . . . . . . .
Pre-formed Crumb . . . . . . . .
Refrigerated Pastry . . . . . . .
BRANDS:
Keebler Ready Crust . . . . . .
Nabisco . . . . . . . . . . . . . . . .
Pillsbury . . . . . . . . . . . . . . . .
OTHER (Write In)
OTHER (Write In)
SEASONINGS &
SPICES
BROWNIE &
COOKIE MIXES
754
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Betty Crocker Wild
Blueberry Muffins . . . . . . .
Other Betty Crocker Muffins
Betty Crocker Quick Breads . .
Bisquick . . . . . . . . . . . . . . . .
Bisquick Heart Smart . . . . . .
749
FROSTINGS
Your Household:
Used in
Packages/
last 6
last 30
months
days
PUDDINGS & PIE
FILLINGS
00
01
02
03
04
05
06
07
08
999
Your Household:
Used in
Containers/
last 6
last 30
months
days
756
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Powdered Instant . . . . . . . . .
Powdered Regular . . . . . . . .
Ready to Eat. . . . . . . . . . . . .
KINDS:
Regular. . . . . . . . . . . . . . . . .
Sugar-Free . . . . . . . . . . . . . .
Fat-Free . . . . . . . . . . . . . . . .
FORMS:
Refrigerated . . . . . . . . . . . . .
Shelf-Stable . . . . . . . . . . . . .
BRANDS:
Comstock . . . . . . . . . . . . . . .
Hunt’s Snack Pack . . . . . . . .
Jell-O Pudding . . . . . . . . . . .
Jell-O Pudding (Fat/Sugar
Free) . . . . . . . . . . . . . . . . .
Jell-O Pudding Snacks . . . . .
Jell-O Pudding Snacks
(Fat Free) . . . . . . . . . . . . .
Jell-O Pudding Snacks
(Sugar Free) . . . . . . . . . . .
Kozy Shack Pudding . . . . . .
Kraft Handi-Snacks Pudding. .
Libby’s 100% Pure
Pumpkin . . . . . . . . . . . . . .
Minute Tapioca . . . . . . . . . . .
Mousse Temptations by
Jell-O . . . . . . . . . . . . . . . .
My-T-Fine . . . . . . . . . . . . . . .
Royal . . . . . . . . . . . . . . . . . .
Swiss Miss Pudding . . . . . . .
OTHER (Write In)
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
999
FOOD
Page 93
COOKIES
(Ready to Eat)
Your Household:
Used in
Boxes or
last 6
packages/
months
last 30 days
757
TOTAL:
00
TYPES:
Butter . . . . . . . . . . . . . . . . . .
Chocolate Chip. . . . . . . . . . .
Chocolate Covered. . . . . . . .
Figbars . . . . . . . . . . . . . . . . .
Fudge . . . . . . . . . . . . . . . . . .
Oatmeal . . . . . . . . . . . . . . . .
Peanut Butter . . . . . . . . . . . .
Sandwich . . . . . . . . . . . . . . .
Shortbread . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . .
KINDS:
Regular. . . . . . . . . . . . . . . . .
Low Fat. . . . . . . . . . . . . . . . .
Fat Free . . . . . . . . . . . . . . . .
Sugar Free . . . . . . . . . . . . . .
11
12
13
14
PACKAGE SIZE:
100 Calorie Pack . . . . . . . . . Other Package Size . . . . . . . 15
16
BRANDS:
Archway . . . . . . . . . . . . . . . .
Entenmann’s . . . . . . . . . . . . .
Famous Amos . . . . . . . . . . . .
Kashi . . . . . . . . . . . . . . . . . .
Keebler Animal Cookies . . . . .
Keebler Chips Deluxe. . . . . . .
Keebler E. L. Fudge Sandwich
Keebler Fudge Sticks . . . . . . .
Keebler Fudge Stripes . . . . . .
Keebler Simply Made . . . . . . .
Other Keebler . . . . . . . . . . . .
Little Debbie Nutty Bars . . . . .
Little Debbie Oatmeal
Creme Pies . . . . . . . . . . . .
Other Little Debbie . . . . . . . .
LU Biscuits . . . . . . . . . . . . . .
Mother’s . . . . . . . . . . . . . . . .
Murray. . . . . . . . . . . . . . . . . .
Nabisco Chips Ahoy! . . . . . . .
Nabisco Chunky Chips Ahoy! .
Nabisco Newtons. . . . . . . . . .
Nabisco Newtons Fruit Thins .
Nabisco Nilla Wafers . . . . . . .
Nabisco Nutter Butter . . . . . . .
Nabisco Oreo. . . . . . . . . . . . .
Nabisco Double Stuf Oreo . . .
Nabisco Teddy Grahams . . . .
Other Nabisco . . . . . . . . . . . .
Pepperidge Farm . . . . . . . . . .
Quaker . . . . . . . . . . . . . . . . .
Stella D’oro . . . . . . . . . . . . . .
Store’s Own Brand . . . . . . . . .
OTHER (Write In)
01
02
03
04
05
06
07
08
09
10
PACKAGE SIZE:
100 Calorie Pack . . . . . . . . .
Other Package Size . . . . . . .
BRANDS:
Entenmann’s. . . . . . . . . . . . .
Hostess . . . . . . . . . . . . . . . .
Little Debbie . . . . . . . . . . . . .
Otis Spunkmeyer . . . . . . . . .
Bakery . . . . . . . . . . . . . . . . .
Store’s Own Bakery . . . . . . .
OTHER (Write In)
SNACK CAKES
00
01
02
03
04
05
06
07
08
09
999
Your Household:
Used in
Boxes or
last 6
Packages/
months
last 30 days
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
TOTAL: . . . . . . . . . . . . . . . . . TYPES:
Lowfat/Fat Free. . . . . . . . . . . Regular. . . . . . . . . . . . . . . . . PACKAGE SIZE:
100 Calorie Pack . . . . . . . . .
Other Package Size . . . . . . .
BRANDS:
Drake’s . . . . . . . . . . . . . . . . .
Entenmann’s. . . . . . . . . . . . .
Hostess CupCakes. . . . . . . .
Hostess Twinkies . . . . . . . . .
Other Hostess . . . . . . . . . . .
Little Debbie . . . . . . . . . . . . .
Marinela . . . . . . . . . . . . . . . .
MoonPie . . . . . . . . . . . . . . . .
Mrs. Freshley’s . . . . . . . . . . . .
Sara Lee. . . . . . . . . . . . . . . .
Tastykake . . . . . . . . . . . . . . .
Weight Watchers . . . . . . . . .
00
01
02
03
04
05
06
07
08
999
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
999
OTHER (Write In)
TOASTER
PRODUCTS
Your Household:
Used in
Packages
last 6
last 30
months
days
761
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Kellogg’s Pop-Tarts . . . . . . .
Pillsbury Toaster Scrambles
Pillsbury Toaster Strudel. . . .
Toast’em Pop-ups. . . . . . . . .
READY TO EAT
DOUGHNUTS
00
01
02
03
04
05
OTHER (Write In)
FRUIT SNACKS
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
999
Your Household:
Used in
Snacks/
last 6
last 30
months
days
995
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Betty Crocker Fruit By
The Foot . . . . . . . . . . . . .
Betty Crocker Fruit Roll-Ups
Betty Crocker Fruit Gushers
Other Betty Crocker . . . . . . .
Brach’s Fruit Snacks. . . . . . .
Dole Real Fruit Bites. . . . . . .
Kellogg’s Fruity Snacks . . .
Mott’s Medleys . . . . . . . . . .
Ocean Spray Craisins . . . . .
Sun-Maid Raisins . . . . . . . . .
Sunsweet Fruit Snacks. . . . .
Welch’s Fruit Snacks . . . . . .
00
01
02
03
04
05
06
07
08
09
10
11
12
13
999
OTHER (Write In)
READY TO EAT
SWEET ROLLS &
PASTRIES
999
Your Household:
Used in
Packages/
last 6
Boxes last
months
30 days
770
Your Household:
Used in
Packages/
last 6
Boxes last
months
30 days
758
TOTAL . . . . . . . . . . . . . . . . . . . BRANDS:
Dunkin’ Donuts. . . . . . . . . . . .
Entenmann’s . . . . . . . . . . . . .
Hostess . . . . . . . . . . . . . . . . .
Krispy Kreme. . . . . . . . . . . . .
Little Debbie . . . . . . . . . . . . .
Tastykake . . . . . . . . . . . . . . .
Fresh Doughnut Shop . . . . . .
Bakery. . . . . . . . . . . . . . . . . .
Store’s Own Bakery . . . . . . . .
OTHER (Write In)
Your Household:
Used in
Bars/
last 6
last 30
months
days
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Cascadian Farm Bars. . . . . .
Entenmann’s Cereal Bar. . . .
Fiber One Chewy Bars . . . . .
General Mills Milk ’n
Cereal Bars. . . . . . . . . . . .
Kashi Bars . . . . . . . . . . . . . .
Kellogg’s FiberPlus Bar . . . .
Kellogg’s Nutri-Grain Bar . . .
Kellogg’s Rice Krispies
Treats . . . . . . . . . . . . . . . .
Kellogg’s Special K Bar . . . .
KIND Bars . . . . . . . . . . . . . .
Little Debbie . . . . . . . . . . . . .
Nature Valley Granola Bars .
Nature’s Path . . . . . . . . . . . .
Quaker Cereal Bars . . . . . . .
Quaker Chewy Granola Bar
Quaker Real Medleys Bar . .
Other Quaker . . . . . . . . . . . .
Sunbelt Fruit & Grain Bars . .
Sunbelt Granola Bars . . . . . .
OTHER (Write In)
47
999
BREAKFAST/
CEREAL/
GRANOLA BARS
763
753
Your Household:
Used in
Packages/
last 6
Boxes last
months
30 days
................. TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Refrigerated/Ready to Eat . .
Powder/Mix. . . . . . . . . . . . . .
BRANDS:
Jell-O Gelatin . . . . . . . . . . . .
Jell-O Gelatin Snacks . . . . .
Jell-O Gelatin Sugar Free
Snacks . . . . . . . . . . . . . . .
Jell-O Sugar Free Gelatin. . .
Knox . . . . . . . . . . . . . . . . . .
Royal . . . . . . . . . . . . . . . . . .
OTHER (Write In)
765
TOTAL:
Your Household:
Used in
Packages/
last 6
last 30
months
days
759
................. READY TO EAT
MUFFINS
GELATIN AND
GELATIN DESSERTS
00
01
02
03
04
05
06
07
08
09
999
TOTAL:
................. TYPES:
Cinnamon Rolls . . . . . . . . . .
Coffee Cake . . . . . . . . . . . . .
Cupcakes . . . . . . . . . . . . . . .
Danish Rolls . . . . . . . . . . . . .
Honey Buns . . . . . . . . . . . . .
Pies . . . . . . . . . . . . . . . . . . . Turnovers . . . . . . . . . . . . . . . BRANDS:
Entenmann’s. . . . . . . . . . . . .
Hostess . . . . . . . . . . . . . . . .
Little Debbie . . . . . . . . . . . . .
Mrs. Freshley’s . . . . . . . . . . .
Tastykake . . . . . . . . . . . . . . .
00
01
02
03
04
05
06
07
08
09
10
11
12
13
999
FOOD
Page 94
BREAKFAST CEREALS
(Cold)
Your Household:
Used in
Individual
last 6
portions/
months
last 7 days
766
TOTAL: . . . . . . . . . . . . . . . . . BRANDS:
Basic 4 . . . . . . . . . . . . . . . . . Bear Naked Granola . . . . . . Cap’n Crunch (Regular) . . . . Cap’n Crunch CrunchBerries Cap’n Crunch Peanut Butter
Crunch . . . . . . . . . . . . . . . Cascadian Farm . . . . . . . . . . Cheerios. . . . . . . . . . . . . . . . Apple Cinnamon Cheerios . . Chocolate Cheerios . . . . . . . Frosted Cheerios . . . . . . . . . Fruity Cheerios. . . . . . . . . . . Honey Nut Cheerios. . . . . . . Multi Grain Cheerios . . . . . . Corn Chex . . . . . . . . . . . . . . Honey Nut Chex . . . . . . . . . . Rice Chex. . . . . . . . . . . . . . . Wheat Chex . . . . . . . . . . . . . Cinnamon Toast Crunch. . . . Cocoa Puffs . . . . . . . . . . . . . Cookie Crisp. . . . . . . . . . . . . Count Chocula . . . . . . . . . . . Fiber One . . . . . . . . . . . . . . . General Mills Reese’s Puffs . Golden Grahams . . . . . . . . . Kashi GOLEAN Crisp! . . . . . Kashi GOLEAN Crunch!. . . . Kashi Heart to Heart. . . . . . . Other Kashi . . . . . . . . . . . . . Kellogg’s All-Bran . . . . . . . . . Kellogg’s All-Bran Complete Kellogg’s Apple Jacks . . . . . . Kellogg’s Cocoa Krispies . . . Kellogg’s Corn Flakes. . . . . . Kellogg’s Corn Pops . . . . . . . Kellogg’s Cracklin’ Oat Bran Kellogg’s Crispix . . . . . . . . . . Kellogg’s Crunchy Nut . . . . . Kellogg’s Fiber Plus . . . . . . . Kellogg’s Froot Loops . . . . . . Kellogg’s Frosted Flakes. . . . Kellogg’s Frosted MiniWheats . . . . . . . . . . . . . . . Kellogg’s Honey Smacks . . . Kellogg’s Krave. . . . . . . . . . . Kellogg’s Low Fat Granola . . Kellogg’s Marshmallow
Froot Loops. . . . . . . . . . . . Kellogg’s Product 19 . . . . . . . Kellogg’s Raisin Bran . . . . . . Kellogg’s Raisin Bran
Crunch . . . . . . . . . . . . . . . Kellogg’s Rice Krispies . . . . . Kellogg’s Rice Krispies Treats
Cereal . . . . . . . . . . . . . . . . Kellogg’s Smart Start . . . . . . Kellogg’s Special K. . . . . . . . Kellogg’s Special K
Chocolatey Delight . . . . . . Kellogg’s Special K Red
Berries . . . . . . . . . . . . . . . Kellogg’s Special K Vanilla
Almond . . . . . . . . . . . . . . . Kellogg’s Special K Protein. . Other Kellogg’s . . . . . . . . . . . Kix . . . . . . . . . . . . . . . . . . . . Life . . . . . . . . . . . . . . . . . . . . Life Cinnamon . . . . . . . . . . . Lucky Charms . . . . . . . . . . . Malt-O-Meal . . . . . . . . . . . . . Oatmeal Crisp Crunchy
Almond . . . . . . . . . . . . . . . 00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
BREAKFAST CEREALS
(Cold)
(Continued)
Your Household:
Used in
Individual
last 6
portions/
months
last 7 days
Oatmeal Crisp Hearty
Raisin . . . . . . . . . . . . . . . .
Post Blueberry Morning . . . .
Post Grape-Nuts. . . . . . . . . .
Post Grape-Nuts Flakes . . . .
Post Great Grains. . . . . . . . .
Post Honey Bunches of Oats
Post Honey Bunches of Oats
w/Strawberries . . . . . . . . . .
Post Honeycomb . . . . . . . . .
Post Honey Nut
Shredded Wheat . . . . . . . .
Post Pebbles (Cocoa). . . . . .
Post Pebbles (Fruity) . . . . . .
Post Raisin Bran. . . . . . . . . .
Post Regular Size
Post Spoon Size
Post Shredded Wheat ’n
Bran . . . . . . . . . . . . . . . . .
Other Post . . . . . . . . . . . . . .
Quaker Puffed Rice . . . . . . .
Quaker Puffed Wheat . . . . . .
Quaker Oatmeal Squares. . .
Raisin Nut Bran . . . . . . . . . .
Total . . . . . . . . . . . . . . . . . . .
Total Raisin Bran . . . . . . . . .
Trix . . . . . . . . . . . . . . . . . . . .
Van’s . . . . . . . . . . . . . . . . . . .
Wheaties . . . . . . . . . . . . . . .
OTHER (Write In)
BREAKFAST
CEREALS
(Hot)
Your Household:
Used in
Packages/
last 6
last 30
months
days
768
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
186
187
88
89
999
Your Household:
Used in
Individual
last 6
portions/
months
last 7 days
764
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Aunt Jemima Grits . . . . . . . .
Cream of Rice . . . . . . . . . . .
Cream of Wheat Instant . . . .
Cream of Wheat
Regular/Stovetop . . . . . . .
Farina . . . . . . . . . . . . . . . . . .
Kashi GOLEAN . . . . . . . . . .
Kashi Heart to Heart. . . . . . .
Malt-O-Meal . . . . . . . . . . . . .
Oat Revolution!. . . . . . . . . . .
Quaker Instant Oatmeal . . . .
Quaker Oat Bran . . . . . . . . .
Quaker Quick Oats. . . . . . . .
Quaker Real Medleys . . . . . .
Quaker Warm & Crunchy . . .
Quaker Weight Control . . . . .
Old Fashioned Quaker Oats
Quaker Instant Grits . . . . . . .
Quaker Quick Grits. . . . . . . .
Special K Hot Cereals . . . . .
OTHER (Write In)
FROZEN BREAKFASTS
00
01
02
03
04
05
06
07
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Aunt Jemima Frozen
Breakfasts. . . . . . . . . . . . .
Bob Evans . . . . . . . . . . . . . .
Hot Pockets Breakfast . . . . .
Jimmy Dean Biscuit
Sandwiches . . . . . . . . . . .
Jimmy Dean Breakfast Bowls .
10
00
02
Jimmy Dean Delights . . . . . . Jimmy Dean Skillets . . . . . . . Other Jimmy Dean . . . . . . . . Kellogg’s Special K Flatbread
Breakfast Sandwich . . . . . Pillsbury Grands! Biscuit
Sandwich . . . . . . . . . . . . . Tennessee Pride. . . . . . . . . . Weight Watchers Smart
Ones . . . . . . . . . . . . . . . . . Store’s Own Brand . . . . . . . . 01
03
04
05
06
07
08
09
10
11
12
13
999
OTHER (Write In)
FROZEN WAFFLES
Your Household:
Used in
Packages/
last 6
last 30
months
days
769
TOTAL:
................. TYPES:
Buttermilk . . . . . . . . . . . . . . .
Fruit Flavored . . . . . . . . . . . .
Whole Wheat . . . . . . . . . . . .
Regular. . . . . . . . . . . . . . . . .
BRANDS:
Aunt Jemima . . . . . . . . . . . .
Eggo Blueberry . . . . . . . . . .
Eggo Cinnamon Toast . . . . .
Eggo Homestyle Waffles . . .
Eggo Nutri-Grain Waffles . . .
Eggo Wafflers . . . . . . . . . . . .
Other Eggo Waffles . . . . . . .
Kashi . . . . . . . . . . . . . . . . . .
Van’s . . . . . . . . . . . . . . . . . . .
OTHER (Write In)
08
09
FROZEN PANCAKES/
FRENCH TOAST
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
999
Your Household:
Used in
Packages/
last 6
last 30
months
days
11
12
13
14
15
16
17
18
19
20
999
767
................. 00
TYPES:
Buttermilk . . . . . . . . . . . . . . . Regular. . . . . . . . . . . . . . . . . 02
TOTAL:
BRANDS:
Aunt Jemima French Toast . .
Aunt Jemima Pancakes . . . .
De Wafelbakkers . . . . . . . . .
Eggo French Toaster Sticks .
Eggo Pancakes . . . . . . . . . .
Farm Rich French Toast
Sticks . . . . . . . . . . . . . . . .
Krusteaz French Toast/
Pancakes . . . . . . . . . . . . .
Pillsbury Pancakes . . . . . . . .
Van’s . . . . . . . . . . . . . . . . . . .
OTHER (Write In)
01
03
04
05
06
07
08
09
10
11
12
999
FOOD
Page 95
WAFFLE OR
PANCAKE MIX
Your Household:
Used in
Containers/
last 6
last 30
months
days
JAMS & JELLIES
READY TO
SERVE DIPS
774
771
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Dry Mix . . . . . . . . . . . . . . . . .
Ready to Pour. . . . . . . . . . . .
BRANDS:
Aunt Jemima Complete . . . .
Other Aunt Jemima. . . . . . . .
Betty Crocker Pancake Mix .
Bisquick . . . . . . . . . . . . . . . .
Bisquick Heart Smart . . . . . .
Bisquick Shake ’n Pour . . . . .
Fiber One . . . . . . . . . . . . . . .
Hungry Jack . . . . . . . . . . . . .
Jiffy . . . . . . . . . . . . . . . . . . . .
Krusteaz Buttermilk Complete
Pancake Mix . . . . . . . . . . .
Mrs. Butterworth’s . . . . . . . . .
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
999
OTHER (Write In)
TABLE SYRUP,
MOLASSES
& AGAVE
Your Household:
Used in
Jars/
last 6
last 30
months
days
Your Household:
Used in
Bottles or
last 6
containers/
months
last 30 days
777
................. TYPES:
Regular. . . . . . . . . . . . . . . . .
Light . . . . . . . . . . . . . . . . . . .
Sugar Free/No Sugar Added .
FORMS:
Jam. . . . . . . . . . . . . . . . . . . .
Jelly . . . . . . . . . . . . . . . . . . .
Preserves . . . . . . . . . . . . . . .
Marmalade . . . . . . . . . . . . . .
All Fruit . . . . . . . . . . . . . . . . .
KINDS:
Grape . . . . . . . . . . . . . . . . . .
Strawberry . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . .
BRANDS:
Bama . . . . . . . . . . . . . . . . . .
Knott’s Berry Farm . . . . . . . .
Polaner . . . . . . . . . . . . . . . . .
Smucker’s. . . . . . . . . . . . . . .
Welch’s . . . . . . . . . . . . . . . . .
Store’s Own Brand . . . . . . . . 00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
999
OTHER (Write In)
772
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Lite/Low calorie . . . . . . . . . .
Regular. . . . . . . . . . . . . . . . .
Sugar Free . . . . . . . . . . . . . .
FORMS:
Table Syrup. . . . . . . . . . . . . .
Molasses . . . . . . . . . . . . . . .
Agave Nectar . . . . . . . . . . . .
BRANDS:
Agave in the Raw . . . . . . . . .
Aunt Jemima Lite . . . . . . . . .
Aunt Jemima Original . . . . . .
Aunt Jemima Butter Lite . . . .
Aunt Jemima Butter Rich . . .
Aunt Jemima Country Rich . .
Brer Rabbit Molasses . . . . . .
Country Kitchen . . . . . . . . . .
Golden Griddle . . . . . . . . . . .
Grandma’s Molasses . . . . . .
Hungry Jack Lite. . . . . . . . . .
Hungry Jack Original . . . . . .
Hungry Jack Butter
Flavored . . . . . . . . . . . . . .
Karo Pancake . . . . . . . . . . . .
Log Cabin Lite . . . . . . . . . . .
Log Cabin Original . . . . . . . .
Other Log Cabin . . . . . . . . . .
Maple Grove Farms . . . . . . .
Mrs. Butterworth’s Lite . . . . .
Mrs. Butterworth’s Original . .
Mrs. Butterworth’s Sugar
Free . . . . . . . . . . . . . . . . .
Vermont Maid . . . . . . . . . . . .
TOTAL:
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
999
PEANUT BUTTER
&
OTHER NUT SPREADS
Your Household:
Used in
Jars/
last 6
last 30
months
days
776
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Creamy. . . . . . . . . . . . . . . . .
Crunchy . . . . . . . . . . . . . . . .
KINDS:
Natural . . . . . . . . . . . . . . . . .
BRANDS:
Jif . . . . . . . . . . . . . . . . . . . . .
Jif Chocolate Hazelnut . . . . .
Jif Natural . . . . . . . . . . . . . . .
Jif Reduced Fat . . . . . . . . . .
Jif Omega-3 . . . . . . . . . . . . .
00
02
03
Jif Whips. . . . . . . . . . . . . . . .
Simply Jif . . . . . . . . . . . . . . .
Nutella . . . . . . . . . . . . . . . . .
Peter Pan Plus . . . . . . . . . . .
Peter Pan Regular . . . . . . . .
Planters . . . . . . . . . . . . . . . .
Reese’s. . . . . . . . . . . . . . . . .
Skippy Natural . . . . . . . . . . .
Skippy Regular . . . . . . . . . . .
Skippy Reduced Fat . . . . . . .
Skippy Roasted Honey Nut. .
Smart Balance . . . . . . . . . . .
Smucker’s . . . . . . . . . . . . . . .
OTHER (Write In)
OTHER (Write In)
HONEY
01
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
999
773
TOTAL: . . . . . . . . . . . . . . . . .
FLAVORS:
Bacon & Horseradish . . . . . .
Bean. . . . . . . . . . . . . . . . . . .
Blue Cheese. . . . . . . . . . . . .
Other Cheese. . . . . . . . . . . .
Caramel . . . . . . . . . . . . . . . .
00
01
02
03
04
05
Chocolate . . . . . . . . . . . . . . .
Hummus. . . . . . . . . . . . . . . .
French Onion . . . . . . . . . . . .
Green Onion. . . . . . . . . . . . .
Guacamole/Avocado . . . . . .
06
07
08
09
10
Jalapeño. . . . . . . . . . . . . . . .
Ranch. . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . .
BRANDS:
Athenos . . . . . . . . . . . . . . . .
Cedar’s . . . . . . . . . . . . . . . . .
Cheez Whiz . . . . . . . . . . . . .
Dean’s . . . . . . . . . . . . . . . . .
Frito-Lay . . . . . . . . . . . . . . . .
11
12
13
14
15
16
17
18
Heluva Good! . . . . . . . . . . . .
Kraft . . . . . . . . . . . . . . . . . . .
Lay’s . . . . . . . . . . . . . . . . . . .
Marzetti. . . . . . . . . . . . . . . . .
Sabra . . . . . . . . . . . . . . . . . .
Tostitos . . . . . . . . . . . . . . . . .
Tribe . . . . . . . . . . . . . . . . . . .
Wholly Guacamole . . . . . . . .
OTHER (Write In)
AMERICAN
PASTEURIZED
PROCESSED CHEESE
19
20
21
22
23
24
25
26
27
999
Your Household:
Used in
Pounds/
last 6
last 30
months
days
778
Your Household:
Used in
Containers
last 6
or jars/last
months
6 months
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Burleson’s. . . . . . . . . . . . . . .
Golden Blossom. . . . . . . . . .
Sue Bee . . . . . . . . . . . . . . . .
OTHER (Write In)
Your Household:
Used in
Containers/
last 6
last 30
months
days
00
01
02
03
04
05
999
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Light/Lite. . . . . . . . . . . . . . . .
Low Fat. . . . . . . . . . . . . . . . .
Fat Free . . . . . . . . . . . . . . . .
Regular. . . . . . . . . . . . . . . . .
FORMS:
Chunk. . . . . . . . . . . . . . . . . .
Shredded . . . . . . . . . . . . . . .
Individually Wrapped Slices .
Other Pre-Sliced . . . . . . . . . .
Loaf/Brick/Boxed . . . . . . . . .
KINDS:
Pre-Packaged . . . . . . . . . . . .
Deli . . . . . . . . . . . . . . . . . . . .
BRANDS:
Alpine Lace. . . . . . . . . . . . . .
Boar’s Head . . . . . . . . . . . . .
Borden 2% Milk . . . . . . . . . .
Borden Fat Free Singles. . . .
Borden Singles . . . . . . . . . . .
Crystal Farms . . . . . . . . . . . .
Kraft Deli Deluxe. . . . . . . . . .
Kraft Fat Free Singles. . . . . .
Kraft 2% Milk Singles . . . . . .
Kraft Singles . . . . . . . . . . . . .
Other Kraft . . . . . . . . . . . . . .
Land O’Lakes . . . . . . . . . . . .
Velveeta . . . . . . . . . . . . . . . .
Velveeta 2% Milk . . . . . . . . .
Velveeta Mexican Mild . . . . .
OTHER (Write In)
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
999
FOOD
Page 96
NATURAL OR
IMPORTED CHEESE
Your Household:
Used in
Pounds/
last 6
last 30
months
days
COTTAGE CHEESE
779
OTHER (Write In)
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
999
Your Household:
Used in
Containers/
last 6
last 30
months
days
780
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Deli — Pre-Packaged . . . . . .
Deli — Fresh . . . . . . . . . . . .
Dry/Canned . . . . . . . . . . . . .
KINDS:
Parmesan . . . . . . . . . . . . . . .
Romano . . . . . . . . . . . . . . . .
Parmesan/Romano Blend . .
BRANDS:
4C. . . . . . . . . . . . . . . . . . . . .
Kraft . . . . . . . . . . . . . . . . . . .
OTHER (Write In)
CRACKERS
00
01
02
03
04
05
06
07
08
09
999
TOTAL:
................. TYPES:
Axelrod . . . . . . . . . . . . . . . . .
Breakstone’s . . . . . . . . . . . . .
Daisy . . . . . . . . . . . . . . . . . .
Dean’s . . . . . . . . . . . . . . . . .
Friendship. . . . . . . . . . . . . . .
Hood. . . . . . . . . . . . . . . . . . .
Knudsen . . . . . . . . . . . . . . . .
Prairie Farms . . . . . . . . . . . .
Simply Kraft . . . . . . . . . . . . .
OTHER (Write In)
CREAM CHEESE
00
01
02
03
04
05
06
07
08
09
10
11
12
13
999
Your Household:
Used in
Packages/
last 6
last 30
months
days
782
................. 00
TYPES:
Flavored . . . . . . . . . . . . . . . . Regular/Unflavored. . . . . . . . 01
02
FORMS:
Brick . . . . . . . . . . . . . . . . . . . Soft . . . . . . . . . . . . . . . . . . . . Whipped . . . . . . . . . . . . . . . . 03
04
05
KINDS:
Fat Free . . . . . . . . . . . . . . . . Reduced Fat . . . . . . . . . . . . . Regular. . . . . . . . . . . . . . . . . 06
07
08
BRANDS:
Philadelphia Regular . . . . . .
Philadelphia 1/3 Less Fat. . . .
Philadelphia Fat Free . . . . . .
Temp Tee . . . . . . . . . . . . . . .
09
10
11
12
13
Store’s Own Brand . . . . . . . . 14
999
TOTAL:
OTHER (Write In)
Used For:
783-0
Cooking/Baking . . . . . . . . . . 1
Spreading . . . . . . . . . . . . . . 2
SPREAD CHEESE/
CHEESE SAUCE
Your Household:
Used in
Packages/
last 6
last 30
months
days
784
TOTAL:
................. TYPES:
Aerosol Can . . . . . . . . . . . . .
Balls/Logs. . . . . . . . . . . . . . .
Crock/Tub . . . . . . . . . . . . . . .
Jar/Cup. . . . . . . . . . . . . . . . .
Squeeze Bottle . . . . . . . . . . .
00
01
02
03
04
05
KINDS:
Sauce . . . . . . . . . . . . . . . . . . Spread . . . . . . . . . . . . . . . . . 06
07
BRANDS:
Alouette . . . . . . . . . . . . . . . .
Boursin Spreadable . . . . . . .
Cheez Whiz . . . . . . . . . . . . .
Easy Cheese . . . . . . . . . . . .
Kaukauna . . . . . . . . . . . . . . .
Price*s . . . . . . . . . . . . . . . . .
WisPride . . . . . . . . . . . . . . . .
OTHER (Write In)
Your Household:
Used in
Boxes/
last 6
last 30
months
days
785
781
TOTAL: . . . . . . . . . . . . . . . . .
FORMS:
Chunk. . . . . . . . . . . . . . . . . .
Loaf . . . . . . . . . . . . . . . . . . .
Pre-Sliced . . . . . . . . . . . . . . .
Shredded . . . . . . . . . . . . . . .
String . . . . . . . . . . . . . . . . . .
Cheese Stick . . . . . . . . . . . .
TYPES:
Fat Free . . . . . . . . . . . . . . . .
Low Fat/Low Cholesterol . . .
Low Sodium . . . . . . . . . . . . .
Regular. . . . . . . . . . . . . . . . .
KINDS:
Blue Cheese. . . . . . . . . . . . .
Brie. . . . . . . . . . . . . . . . . . . .
Cheddar . . . . . . . . . . . . . . . .
Colby . . . . . . . . . . . . . . . . . .
Edam . . . . . . . . . . . . . . . . . .
Feta . . . . . . . . . . . . . . . . . . .
Goat . . . . . . . . . . . . . . . . . . .
Gouda . . . . . . . . . . . . . . . . .
Havarti . . . . . . . . . . . . . . . . .
Jarlsberg. . . . . . . . . . . . . . . .
Monterey Jack . . . . . . . . . . .
Mozzarella . . . . . . . . . . . . . .
Muenster . . . . . . . . . . . . . . .
Parmesan . . . . . . . . . . . . . . .
Pepper Jack . . . . . . . . . . . . .
Provolone . . . . . . . . . . . . . . .
Ricotta . . . . . . . . . . . . . . . . .
Romano . . . . . . . . . . . . . . . .
Swiss . . . . . . . . . . . . . . . . . .
Cheese Blends. . . . . . . . . . .
BRANDS:
Alpine Lace. . . . . . . . . . . . . .
Athenos . . . . . . . . . . . . . . . .
Babybel . . . . . . . . . . . . . . . .
Borden . . . . . . . . . . . . . . . . .
Boursin . . . . . . . . . . . . . . . . .
Cabot . . . . . . . . . . . . . . . . . .
Cracker Barrel . . . . . . . . . . .
Crystal Farms . . . . . . . . . . . .
Frigo . . . . . . . . . . . . . . . . . . .
Galbani. . . . . . . . . . . . . . . . .
Heluva Good! . . . . . . . . . . . .
Kraft . . . . . . . . . . . . . . . . . . .
Land O’Lakes . . . . . . . . . . . .
The Laughing Cow . . . . . . . .
Polly-O . . . . . . . . . . . . . . . . .
Sargento (Regular) . . . . . . . .
Sargento (Reduced Fat) . . . .
Tillamook . . . . . . . . . . . . . . .
GRATED CHEESE
Your Household:
Used in
Containers/
last 6
last 30
months
days
08
09
10
11
12
13
14
15
999
TOTAL:
................. TYPES:
Butter-Flavored . . . . . . . . . . .
Cheese. . . . . . . . . . . . . . . . .
Crispbread . . . . . . . . . . . . . .
Graham . . . . . . . . . . . . . . . .
Oat/Oat Bran . . . . . . . . . . . .
Saltines. . . . . . . . . . . . . . . . .
Sandwich . . . . . . . . . . . . . . .
Sesame . . . . . . . . . . . . . . . .
Wheat/Rye . . . . . . . . . . . . . .
Other Flavored Snack. . . . . .
FORMS:
Low Fat. . . . . . . . . . . . . . . . . Fat Free . . . . . . . . . . . . . . . . Regular. . . . . . . . . . . . . . . . . PACKAGE SIZE:
100 Calorie Pack . . . . . . . . . Other Package Size . . . . . . . BRANDS:
Annie’s Bunnies . . . . . . . . . .
Austin Cracker Sandwiches .
Back to Nature . . . . . . . . . . .
Carr’s . . . . . . . . . . . . . . . . . .
Combos (cracker varieties). .
Kashi Crackers . . . . . . . . . . .
Keebler Club. . . . . . . . . . . . .
Keebler Club Multi-Grain . . .
Keebler Grahams . . . . . . . . .
Keebler Sandwich Crackers
Keebler Town House. . . . . . .
Keebler Zesta Saltines . . . . .
Other Keebler . . . . . . . . . . . .
Kellogg’s Special K
Crackers . . . . . . . . . . . . . .
Lance Sandwich Crackers . .
Nabisco Better Cheddars . . .
Nabisco Cheese Nips. . . . . .
Nabisco Honey Maid
Grahams. . . . . . . . . . . . . .
Nabisco Premium Saltines . .
Nabisco Ritz . . . . . . . . . . . . .
Nabisco Ritz Bits Cheese
Sandwiches . . . . . . . . . . .
Nabisco Ritz Bits Peanut
Butter Sandwiches . . . . . .
Nabisco Ritz Crackerfuls . . .
Nabisco Ritz Fresh Stacks . .
Nabisco Triscuit . . . . . . . . . .
Nabisco Wheat Thins . . . . . .
Other Nabisco . . . . . . . . . . .
Pepperidge Farm Crackers. .
Pepperidge Farm Goldfish . .
Pepperidge Farm Goldfish
Grahams. . . . . . . . . . . . . .
Pepperidge Farm Flavor
Blasted Goldfish . . . . . . . .
RyKrisp. . . . . . . . . . . . . . . . .
Stoned Wheat Thins . . . . . . .
Sunshine Cheez-It . . . . . . . .
Sunshine Krispy Saltines . . .
Van’s . . . . . . . . . . . . . . . . . . . Wasa . . . . . . . . . . . . . . . . . . Store’s Own Brand . . . . . . . . OTHER (Write In)
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
999
FOOD
Page 97
RICE CAKES
Your Household:
Used in
Packages/
last 6
last 30
months
days
POPPING CORN &
POPCORN SNACKS
786
TOTAL:
................. BRANDS:
Quaker . . . . . . . . . . . . . . . . . Store’s Own Brand . . . . . . . . 791
00
01
02
999
OTHER (Write In)
PRETZELS
Your Household:
Used in
Packages/
last 6
last 30
months
days
789
TOTAL:
................. PACKAGE SIZE:
100 Calorie Pack. . . . . . . . . . Other Package Size.. . . . . . . TYPES:
Flavored . . . . . . . . . . . . . . . .
Sourdough . . . . . . . . . . . . . .
BRANDS:
Bachman . . . . . . . . . . . . . . .
Combos (pretzel varieties) . .
Pepperidge Farm Goldfish
Pretzels . . . . . . . . . . . . . . .
Pretzel Crisps . . . . . . . . . . . .
Rold Gold . . . . . . . . . . . . . . .
00
01
02
03
04
05
06
Snyder’s Pretzels . . . . . . . . . Utz . . . . . . . . . . . . . . . . . . . . Store’s Own Brand . . . . . . . . 07
08
09
10
11
12
999
OTHER (Write In)
POTATO CHIPS
Your Household:
Used in
Packages/
last 6
last 30
months
days
787
TOTAL:
................. PACKAGE SIZE:
100 Calorie Pack. . . . . . . . . .
2-5 oz. . . . . . . . . . . . . . . . . .
6-8 oz. . . . . . . . . . . . . . . . . .
10-12 oz.. . . . . . . . . . . . . . . .
More than 12 oz.. . . . . . . . . .
Multi/Variety Pack . . . . . . . .
00
01
02
03
04
05
06
TYPES:
Flavored . . . . . . . . . . . . . . . . Regular. . . . . . . . . . . . . . . . . 07
08
KINDS:
No Salt . . . . . . . . . . . . . . . . . Salted . . . . . . . . . . . . . . . . . . 09
10
BRANDS:
Cape Cod . . . . . . . . . . . . . . .
Herr’s . . . . . . . . . . . . . . . . . .
Jays . . . . . . . . . . . . . . . . . . .
Kettle . . . . . . . . . . . . . . . . . .
Lay’s . . . . . . . . . . . . . . . . . . .
Lay’s Kettle Cooked . . . . . . .
Lay’s Oven Baked. . . . . . . . .
Lay’s Stax . . . . . . . . . . . . . . .
Lay’s Wavy . . . . . . . . . . . . . .
Other Lay’s . . . . . . . . . . . . . .
Munchos. . . . . . . . . . . . . . . .
Popchips. . . . . . . . . . . . . . . .
Pringles Fat Free . . . . . . . . .
Pringles Regular. . . . . . . . . .
Other Pringles . . . . . . . . . . .
Ruffles Regular. . . . . . . . . . .
Other Ruffles . . . . . . . . . . . .
Snyder’s . . . . . . . . . . . . . . . .
Terra . . . . . . . . . . . . . . . . . . .
Utz . . . . . . . . . . . . . . . . . . . .
Wise . . . . . . . . . . . . . . . . . . .
OTHER (Write In)
Your Household:
Packages/
Used in
Bowls
last 6
served/
months
last 30 days
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
999
TOTAL:
................. TYPES:
Popped Corn . . . . . . . . . . . . Popcorn Snacks . . . . . . . . . . Unpopped Corn . . . . . . . . . . BRANDS:
Act II Microwave . . . . . . . . . .
Cracker Jack. . . . . . . . . . . . .
Crunch ’n Munch . . . . . . . . .
Fiddle Faddle . . . . . . . . . . . .
Jiffy Pop . . . . . . . . . . . . . . . .
Jolly Time . . . . . . . . . . . . . . .
Newman’s Own. . . . . . . . . . .
Orville Redenbacher’s
Kettle Korn . . . . . . . . . . . .
Orville Redenbacher’s Butter
(Microwave) . . . . . . . . . . .
Orville Redenbacher’s
SmartPop!. . . . . . . . . . . . .
Other Orville Redenbacher’s .
Pop Secret . . . . . . . . . . . . . .
Pop Weaver . . . . . . . . . . . . .
Popcorn, Indiana . . . . . . . . .
Smartfood . . . . . . . . . . . . . .
Wise . . . . . . . . . . . . . . . . . .
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
999
OTHER (Write In)
CORN, TORTILLA &
OTHER CHIPS &
CHEESE SNACKS
Your Household:
Used in
Packages/
last 6
last 30
months
days
790
TOTAL:
................. PACKAGE SIZE:
2-5 oz. . . . . . . . . . . . . . . . . .
6-8 oz. . . . . . . . . . . . . . . . . .
10-12 oz.. . . . . . . . . . . . . . . .
More than 12 oz.. . . . . . . . . .
Multi/Variety Pack. . . . . . . . .
BRANDS:
Bugles . . . . . . . . . . . . . . . . .
Cheez Doodles. . . . . . . . . . .
Cheetos . . . . . . . . . . . . . . . .
Cheetos Oven Baked . . . . . .
Combos . . . . . . . . . . . . . . . .
Corn Nuts . . . . . . . . . . . . . . .
Doritos Nacho Cheese . . . . .
Doritos Cool Ranch . . . . . . .
Other Doritos . . . . . . . . . . . .
Fritos Regular . . . . . . . . . . . .
Fritos Bar-B-Q. . . . . . . . . . . .
Fritos Chili Cheese . . . . . . . .
Fritos Scoops! . . . . . . . . . . .
Other Fritos . . . . . . . . . . . . .
Funyuns . . . . . . . . . . . . . . . .
Mission Tortilla Chips . . . . . .
Pirate’s Booty . . . . . . . . . . . .
Santitas . . . . . . . . . . . . . . . .
Stacy’s Pita Chips. . . . . . . . .
SunChips . . . . . . . . . . . . . . .
Tostitos Artisan . . . . . . . . . . .
Tostitos Oven Baked. . . . . . .
Tostitos Crispy Rounds. . . . .
Tostitos Restaurant Style . . .
Tostitos Scoops! . . . . . . . . . .
01
796
TOTAL:
................. TYPES:
Condensed . . . . . . . . . . . . . .
Ready to Serve. . . . . . . . . . .
Refrigerated . . . . . . . . . . . . .
Frozen . . . . . . . . . . . . . . . . .
KINDS:
Low Sodium . . . . . . . . . . . . .
Regular. . . . . . . . . . . . . . . . .
BRANDS:
Campbell’s Chunky . . . . . . .
Campbell’s Go . . . . . . . . . . .
Campbell’s Homestyle . . . . .
Campbell’s Slow Kettle . . . . .
Other Campbell’s Ready
to Serve . . . . . . . . . . . . . .
Campbell’s Condensed
Chicken Noodle Soup . . . .
Cream of Mushroom . . . . .
Tomato Soup. . . . . . . . . . .
Other Campbell’s
Condensed Soup . . . . . . .
Campbell’s Healthy Request .
04
04
05
06
07
08
09
10
12
13
14
05
03
Progresso Rich & Hearty . . .
Swanson Broth . . . . . . . . . . .
Wolfgang Puck . . . . . . . . . . .
DRY SOUP &
BOUILLON
01
02
11
OTHER (Write In)
00
College Inn Broth . . . . . . . . .
Healthy Choice . . . . . . . . . . .
Kitchen Basics. . . . . . . . . . . .
Progresso . . . . . . . . . . . . . . .
Progresso Light . . . . . . . . . . .
02
03
Your Household:
Used in
Cans/jars
last 6
last 30
months
days
15
16
17
18
19
20
21
22
23
24
25
999
Your Household:
Used in
Packages/
last 6
last 30
months
days
792
Other Tostitos . . . . . . . . . . . . Utz . . . . . . . . . . . . . . . . . . . . Store’s Own Brand . . . . . . . . OTHER (Write In)
00
CANNED OR JARRED
SOUP/BROTH
................. 06
TOTAL:
07
BRANDS:
Bear Creek Soup Mix . . . . . .
Goya Bouillon . . . . . . . . . . . .
Herb-Ox Bouillon . . . . . . . . .
Knorr Bouillon. . . . . . . . . . . .
Knorr Recipe Mix . . . . . . . . .
01
02
03
04
05
Lipton Cup-a-Soup . . . . . . . .
Lipton Recipe Secrets . . . . .
Lipton Soup Secrets . . . . . . .
Maggi . . . . . . . . . . . . . . . . . .
Maruchan Instant Lunch. . . .
06
07
08
09
10
Maruchan Ramen Soup . . . .
Mrs. Grass Soup & Recipe
Mix . . . . . . . . . . . . . . . . . .
Nissin Cup Noodles . . . . . . .
Nissin Top Ramen . . . . . . . .
Nongshim Bowl Noodle
Soup . . . . . . . . . . . . . . . . .
11
12
13
14
15
Wyler’s Bouillon . . . . . . . . . . Store’s Own Brand . . . . . . . . 16
17
999
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
999
OTHER (Write In)
00
FOOD
Page 98
PIZZA MIXES
AND SAUCES
Your Household:
Used in
Packages/
last 6
last 30
months
days
KETCHUP/CATSUP
844
793
TOTAL:
................. BRANDS:
Boboli . . . . . . . . . . . . . . . . . .
Chef Boyardee . . . . . . . . . . .
Contadina . . . . . . . . . . . . . . .
Ragú Pizza Quick Sauce . . .
Ragú Pizza Sauce . . . . . . . .
OTHER (Write In)
MEXICAN FOODS
00
01
02
03
04
05
Your Household:
Used in
Packages/
last 6
last 30
months
days
OTHER (Write In)
................. 00
01
02
03
04
05
Fajitas. . . . . . . . . . . . . . . . . .
Nachos . . . . . . . . . . . . . . . . .
Refried Beans . . . . . . . . . . .
Seasonings . . . . . . . . . . . . .
Soft Tortillas . . . . . . . . . . . . .
06
07
08
09
10
Taco Dinner Kit . . . . . . . . . . .
Taco Sauce. . . . . . . . . . . . . .
Taco Shells . . . . . . . . . . . . . .
Tortilla Mix . . . . . . . . . . . . . .
Tostados . . . . . . . . . . . . . . . .
11
12
13
14
15
KINDS:
Canned. . . . . . . . . . . . . . . . .
Dry Mix . . . . . . . . . . . . . . . . .
Frozen . . . . . . . . . . . . . . . . .
Refrigerated . . . . . . . . . . . . .
16
17
18
19
BRANDS:
Azteca. . . . . . . . . . . . . . . . . .
Chi-Chi’s. . . . . . . . . . . . . . . .
El Monterey . . . . . . . . . . . . .
Goya. . . . . . . . . . . . . . . . . . .
Guerrero . . . . . . . . . . . . . . . .
José Olé . . . . . . . . . . . . . . . .
La Banderita. . . . . . . . . . . . .
Las Palmas. . . . . . . . . . . . . .
Lawry’s . . . . . . . . . . . . . . . . .
McCormick . . . . . . . . . . . . . .
Mission . . . . . . . . . . . . . . . . .
Old El Paso . . . . . . . . . . . . .
Ortega . . . . . . . . . . . . . . . . .
Rosarita . . . . . . . . . . . . . . . .
Taco Bell. . . . . . . . . . . . . . . .
OTHER (Write In)
BOTTLED BARBECUE
&
SEASONING SAUCES
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
999
Your Household:
Used in
Jars or
last 6
Packages/
months
last 30 days
................. BRANDS:
Chi-Chi’s. . . . . . . . . . . . . . . .
Herdez . . . . . . . . . . . . . . . . .
La Victoria . . . . . . . . . . . . . .
Newman’s Own. . . . . . . . . . .
Old El Paso . . . . . . . . . . . . .
Ortega . . . . . . . . . . . . . . . . .
Pace . . . . . . . . . . . . . . . . . . .
Taco Bell. . . . . . . . . . . . . . . .
Tostitos . . . . . . . . . . . . . . . . .
OTHER (Write In)
00
01
02
03
04
999
00
01
02
03
04
05
06
07
08
09
10
Your Household:
Used in
Bottles/
last 6
last 3
months
months
845
................. TYPES:
Barbecue Sauce. . . . . . . . . .
Chili Sauce . . . . . . . . . . . . . .
Horseradish . . . . . . . . . . . . .
Hot Sauce. . . . . . . . . . . . . . .
Marinade . . . . . . . . . . . . . . .
Seafood Cocktail Sauce . . . .
Steak Sauce . . . . . . . . . . . . .
Tartar Sauce . . . . . . . . . . . . .
Teriyaki Sauce . . . . . . . . . . .
Worcestershire Sauce . . . . .
Other . . . . . . . . . . . . . . . . . .
00
BRANDS:
A.1. Bold & Spicy . . . . . . . . . A.1. Marinade . . . . . . . . . . . . A.1. Original Sauce . . . . . . . Bull’s-Eye Barbecue Sauce . Cattlemen’s Barbecue Sauce Cholula . . . . . . . . . . . . . . . . . Frank’s RedHot Sauce . . . . . French’s . . . . . . . . . . . . . . . . Heinz 57 Sauce . . . . . . . . . . Other Heinz . . . . . . . . . . . . . Hunt’s Barbecue Sauce . . . . Jack Daniel’s Barbecue
Sauce . . . . . . . . . . . . . . . . KC Masterpiece Barbecue
Sauce . . . . . . . . . . . . . . . . KC Masterpiece Marinade . . Kikkoman Teriyaki. . . . . . . . . Kraft Barbecue Sauce
(Original). . . . . . . . . . . . . . Kraft Thick’n Spicy . . . . . . . . Other Kraft . . . . . . . . . . . . . . Lawry’s Marinade . . . . . . . . . Lea & Perrins Worcestershire Louisiana Hot Sauce . . . . . . McCormick Grill Mates . . . . . Open Pit Barbecue Sauce . . Stubb’s . . . . . . . . . . . . . . . . . Sweet Baby Ray’s Barbecue
Sauce . . . . . . . . . . . . . . . . Tabasco Sauce (McIlhenny) Texas Pete . . . . . . . . . . . . . . Weber . . . . . . . . . . . . . . . . . . World Harbors . . . . . . . . . . . Store’s Own Brand . . . . . . . . 01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
999
OTHER (Write In)
795
TOTAL:
SOY SAUCE
Your Household:
Used in
Bottles/
last 6
last 6
months
months
846
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Low Sodium . . . . . . . . . . . . .
Regular. . . . . . . . . . . . . . . . .
BRANDS:
Kikkoman . . . . . . . . . . . . . . .
La Choy . . . . . . . . . . . . . . . .
999
OTHER (Write In)
CANNED BEANS
WITH SAUCE
Your Household:
Used in
Cans/
last 6
last 30
months
days
799
................. BRANDS:
Del Monte . . . . . . . . . . . . . . .
Heinz . . . . . . . . . . . . . . . . . .
Hunt’s . . . . . . . . . . . . . . . . . .
TOTAL:
TYPES:
Burritos. . . . . . . . . . . . . . . . .
Chilies . . . . . . . . . . . . . . . . .
Chili Mixes . . . . . . . . . . . . . .
Enchiladas . . . . . . . . . . . . . .
Enchilada Sauce . . . . . . . . .
SALSA OR
PICANTE SAUCE
TOTAL:
999
794
TOTAL:
Your Household:
Used in
Bottles or
last 6
jars/last
months
30 days
00
01
02
03
04
05
999
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
B&M Baked Beans . . . . . . . .
Brooks Chili Beans . . . . . . .
Bush’s Best Baked Beans . .
Bush’s Best Chili Beans . . . .
Bush’s Best Chili Magic Chili
Starter. . . . . . . . . . . . . . . .
00
01
02
03
04
05
Bush’s Best Grillin’ Beans. . .
Campbell’s Pork & Beans. . .
Goya Beans in Sauce. . . . . .
Hanover Baked Beans . . . . .
Heinz Vegetarian Beans . . . .
06
07
08
09
10
Ranch Style Beans. . . . . . . .
S&W Baked Beans. . . . . . . .
Showboat Pork & Beans . . .
Van Camp’s Baked Beans . .
Van Camp’s Beanee Weenee
11
12
13
14
15
Van Camp’s Pork & Beans . . Store’s Own Brand . . . . . . . . 16
17
999
OTHER (Write In)
CHILI
Your Household:
Used in
Packages/
last 6
last 30
months
days
801
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Regular. . . . . . . . . . . . . . . . .
Without Beans . . . . . . . . . . .
BRANDS:
Armour Chili . . . . . . . . . . . . .
Campbell’s Chunky Chili . . .
Dennison’s . . . . . . . . . . . . . .
Hormel . . . . . . . . . . . . . . . . .
Nalley . . . . . . . . . . . . . . . . . .
Stagg . . . . . . . . . . . . . . . . . .
Wolf Brand Chili . . . . . . . . . .
00
01
02
03
04
05
06
07
08
09
10
999
OTHER (Write In)
CANNED OR
JARRED FRUIT
Your Household:
Used in
Cans or
last 6
Jars/last
months
30 days
760
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Applesauce. . . . . . . . . . . . . .
Cherries . . . . . . . . . . . . . . . .
Cranberries/Cranberry
Sauce . . . . . . . . . . . . . . . .
Fruit Cocktail. . . . . . . . . . . . .
Grapefruit . . . . . . . . . . . . . . .
00
01
02
03
04
05
Oranges . . . . . . . . . . . . . . . .
Peaches . . . . . . . . . . . . . . . .
Pears . . . . . . . . . . . . . . . . . .
Pineapple . . . . . . . . . . . . . . .
06
07
08
09
BRANDS:
Del Monte . . . . . . . . . . . . . . .
Dole . . . . . . . . . . . . . . . . . . .
Libby’s . . . . . . . . . . . . . . . . .
Mott’s . . . . . . . . . . . . . . . . . .
Musselman’s. . . . . . . . . . . . .
Ocean Spray . . . . . . . . . . . .
Polar . . . . . . . . . . . . . . . . . . .
White House . . . . . . . . . . . . .
OTHER (Write In)
10
11
12
13
14
15
16
17
18
999
FOOD
Page 99
CANNED TOMATOES
Your Household:
Used in
Cans/
last 6
last 30
months
days
CANNED OR JARRED
SPAGHETTI &
MACARONI
................. TYPES:
Crushed . . . . . . . . . . . . . . . .
Diced/Chunky/Wedge . . . . .
Paste . . . . . . . . . . . . . . . . . .
Sauce . . . . . . . . . . . . . . . . . .
Stewed . . . . . . . . . . . . . . . . .
Whole . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . .
BRANDS:
Contadina . . . . . . . . . . . . . . .
Del Monte . . . . . . . . . . . . . . .
Hunt’s . . . . . . . . . . . . . . . . . .
Muir Glen . . . . . . . . . . . . . . .
Red Gold . . . . . . . . . . . . . . .
Redpack . . . . . . . . . . . . . . . .
Ro*Tel. . . . . . . . . . . . . . . . . .
S&W . . . . . . . . . . . . . . . . . . .
Tuttorosso . . . . . . . . . . . . . . .
OTHER (Write In)
CANNED OR
JARRED
VEGETABLES
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
999
Your Household:
Used in
Cans or
last 6
jars/last
months
30 days
803
TOTAL: . . . . . . . . . . . . . . . . .
KINDS:
Beans . . . . . . . . . . . . . . . . . .
Carrots . . . . . . . . . . . . . . . . .
Corn . . . . . . . . . . . . . . . . . . .
Mixed . . . . . . . . . . . . . . . . . .
Mushrooms. . . . . . . . . . . . . .
00
01
02
03
04
05
Peas . . . . . . . . . . . . . . . . . . .
Spinach . . . . . . . . . . . . . . . .
FORMS:
Canned. . . . . . . . . . . . . . . . .
Jarred . . . . . . . . . . . . . . . . . .
BRANDS:
Allens . . . . . . . . . . . . . . . . . .
Bush’s Best. . . . . . . . . . . . . .
Del Monte . . . . . . . . . . . . . . .
Food Club. . . . . . . . . . . . . . .
Freshlike . . . . . . . . . . . . . . . .
06
07
08
09
10
11
12
13
14
Giorgio . . . . . . . . . . . . . . . . .
Glory. . . . . . . . . . . . . . . . . . .
Goya. . . . . . . . . . . . . . . . . . .
Green Giant . . . . . . . . . . . . .
Hanover . . . . . . . . . . . . . . . .
Le Sueur. . . . . . . . . . . . . . . .
Libby’s . . . . . . . . . . . . . . . . .
Pennsylvania Dutchman . . . .
Stokely’s . . . . . . . . . . . . . . . .
S&W . . . . . . . . . . . . . . . . . . .
Veg-All . . . . . . . . . . . . . . . . .
OTHER (Write In)
CANNED STEWS
15
16
17
18
19
20
21
22
23
24
25
26
999
Your Household:
Used in
Cans/
last 6
last 30
months
days
804
TOTAL: . . . . . . . . . . . . . . . . . BRANDS:
Dinty Moore . . . . . . . . . . . . . Store’s Own Brand . . . . . . . . OTHER (Write In)
00
01
02
999
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Chef Boyardee . . . . . . . . . . .
SpaghettiOs . . . . . . . . . . . . .
OTHER (Write In)
SPAGHETTI/PASTA
SAUCE
00
01
02
03
999
Your Household:
Used in
Containers/
last 6
last 30
months
days
806
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Canned. . . . . . . . . . . . . . . . .
Jarred . . . . . . . . . . . . . . . . . .
KINDS:
Low Fat/Low Sugar. . . . . . . .
Regular. . . . . . . . . . . . . . . . .
FORMS:
Refrigerated . . . . . . . . . . . . .
Non-Refrigerated . . . . . . . . .
BRANDS:
Barilla . . . . . . . . . . . . . . . . . .
Bertolli . . . . . . . . . . . . . . . . .
Classico . . . . . . . . . . . . . . . .
Del Monte . . . . . . . . . . . . . . .
Francesco Rinaldi. . . . . . . . .
00
01
02
03
04
05
06
Hunt’s . . . . . . . . . . . . . . . . . .
Muir Glen . . . . . . . . . . . . . . .
Newman’s Own. . . . . . . . . . .
Prego Chunky Garden . . . . .
Prego Meat Sauce . . . . . . . .
12
13
14
15
16
Prego Traditional. . . . . . . . . .
Other Prego . . . . . . . . . . . . .
Ragú Cheese Creations . . . .
Ragú Chunky . . . . . . . . . . . .
Ragú Light . . . . . . . . . . . . . .
17
18
19
20
21
Ragú Old World Style. . . . . .
Ragú Organic . . . . . . . . . . . .
Other Ragú. . . . . . . . . . . . . .
OTHER (Write In)
CANNED TUNA
07
08
09
10
11
22
23
24
25
999
Your Household:
Used in
Cans/
last 6
last 30
months
days
797
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Low Sodium . . . . . . . . . . . . .
Regular. . . . . . . . . . . . . . . . .
FORMS:
Packed in water . . . . . . . . . .
Packed in oil . . . . . . . . . . . . .
KINDS:
Solid white . . . . . . . . . . . . . .
Chunk light . . . . . . . . . . . . . .
Chunk white . . . . . . . . . . . . .
BRANDS:
Ace of Diamonds . . . . . . . . .
Bumble Bee . . . . . . . . . . . . .
Chicken of the Sea . . . . . . . .
Geisha . . . . . . . . . . . . . . . . .
StarKist. . . . . . . . . . . . . . . . .
OTHER (Write In)
PACKAGED, FROZEN,
REFRIGERATED
PASTA
Your Household:
Used in
Packages/
last 6
last 30
months
days
808
805
802
TOTAL:
Your Household:
Used in
Cans/jars
last 6
last 30
months
days
00
01
02
03
04
05
06
07
08
09
10
11
12
13
999
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Dry . . . . . . . . . . . . . . . . . . . .
Frozen . . . . . . . . . . . . . . . . .
Refrigerated (Fresh) . . . . . . .
FORMS:
Long . . . . . . . . . . . . . . . . . . .
Stuffed . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . .
KINDS:
Regular. . . . . . . . . . . . . . . . .
Whole Wheat/Whole Grain . .
Gluten Free. . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . .
BRANDS:
American Beauty . . . . . . . . .
Barilla . . . . . . . . . . . . . . . . . .
Barilla Protein Plus . . . . . . . .
Buitoni . . . . . . . . . . . . . . . . .
Celentano . . . . . . . . . . . . . . .
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
Creamette. . . . . . . . . . . . . . .
De Cecco . . . . . . . . . . . . . . .
Dreamfields . . . . . . . . . . . . .
Golden Grain . . . . . . . . . . . .
Light ’n Fluffy . . . . . . . . . . . .
16
17
18
19
20
Mueller’s . . . . . . . . . . . . . . . .
No Yolks . . . . . . . . . . . . . . . .
Pennsylvania Dutch . . . . . . .
Prince . . . . . . . . . . . . . . . . . .
Ronzoni . . . . . . . . . . . . . . . .
21
22
23
24
25
Rosetto . . . . . . . . . . . . . . . . .
San Giorgio . . . . . . . . . . . . .
Skinner . . . . . . . . . . . . . . . . .
Stouffer’s . . . . . . . . . . . . . . .
Wacky Mac . . . . . . . . . . . . . .
26
27
28
29
30
Store’s Own Brand . . . . . . . . 31
999
OTHER (Write In)
LUNCH
COMBINATIONS/
KITS
Your Household:
Used in
Packages/
last 6
last 30
months
days
810
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Armour LunchMakers . . . . . .
Bumble Bee Lunch on the
Run . . . . . . . . . . . . . . . . . .
Lunchables (Oscar Mayer) . .
Lunchables Uploaded
(Oscar Mayer). . . . . . . . . .
Oscar Mayer P3 . . . . . . . . . .
Oscar Mayer Sandwich. . . . .
StarKist Lunch To-Go . . . . . .
OTHER (Write In)
00
01
02
03
04
05
06
07
08
999
FOOD
Page 100
PACKAGED DINNERS
& SIDE DISHES
(MIXES OR PREPARED)
Your Household:
Used in
Packages/
last 6
last 30
months
days
811
00
TYPES:
Microwave . . . . . . . . . . . . . . Regular. . . . . . . . . . . . . . . . . 02
BRANDS:
Annie’s Macaroni & Cheese .
Barilla Italian Entrées . . . . . .
Betty Crocker Suddenly
Pasta Salad . . . . . . . . . . .
Bob Evans
Macaroni & Cheese . . . . .
Bowl Appétit . . . . . . . . . . . .
Chef Boyardee
Microwavable Meals . . . . .
Helper Complete Meals . . . .
Homestyle Bakes . . . . . . . . .
Hormel Compleats . . . . . . . .
Knorr Pasta Sides . . . . . . . .
Kraft Deluxe Macaroni &
Cheese . . . . . . . . . . . . . . .
Kraft Macaroni & Cheese . . .
Kraft Macaroni & Cheese
(Kid’s Shapes) . . . . . . . . .
(Cheesy Alfredo, White
Cheddar, Thick ’n Creamy)
(Microwaveable Cups) . . .
01
03
04
05
06
07
08
09
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Canned. . . . . . . . . . . . . . . . .
Dry Mix . . . . . . . . . . . . . . . . .
BRANDS:
Chicken Helper. . . . . . . . . . .
Del Monte Sloppy Joe
Sauce . . . . . . . . . . . . . . . .
Hamburger Helper . . . . . . . .
Heinz Sloppy Joe Sauce . . .
Manwich . . . . . . . . . . . . . . . .
Not-So-Sloppy-Joe Sloppy
Joe Sauce. . . . . . . . . . . . .
Old El Paso . . . . . . . . . . . . .
Tuna Helper . . . . . . . . . . . . .
Velveeta Cheesy Skillets . . .
10
11
12
13
OTHER (Write In)
STUFFING MIXES
AND STUFFING
PRODUCTS
14
15
16
17
20
Store’s Own Brand . . . . . . . . 23
999
18
19
21
22
OTHER (Write In)
Your Household:
Used in
Packages/
last 6
last 30
months
days
................. TYPES:
Au Gratin . . . . . . . . . . . . . . .
Hash Brown . . . . . . . . . . . . .
Mashed . . . . . . . . . . . . . . . .
Scalloped . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . .
BRANDS:
Betty Crocker Au Gratin
Potatoes . . . . . . . . . . . . . .
Betty Crocker Flavored
Mashed Potatoes . . . . . . .
Betty Crocker Potato Buds . .
Betty Crocker Scalloped
Potatoes . . . . . . . . . . . . . .
Other Betty Crocker . . . . . . .
Hungry Jack Mashed
Potatoes . . . . . . . . . . . . . .
Idaho Spuds . . . . . . . . . . . . .
Idahoan Potatoes . . . . . . . . .
Velveeta Cheesy Potatoes . .
OTHER (Write In)
01
02
03
04
05
06
07
08
09
10
11
12
999
Your Household:
Used in
Packages/
last 6
last 3
months
months
TOTAL: . . . . . . . . . . . . . . . . .
KINDS:
Plain (Unseasoned) . . . . . . .
Seasoned . . . . . . . . . . . . . . .
FLAVORS:
Beef . . . . . . . . . . . . . . . . . . .
Chicken . . . . . . . . . . . . . . . .
Cornbread . . . . . . . . . . . . . .
Herb . . . . . . . . . . . . . . . . . . .
Pork . . . . . . . . . . . . . . . . . . .
Turkey . . . . . . . . . . . . . . . . . .
BRANDS:
Arnold Stuffing . . . . . . . . . . .
Betty Crocker Stuffing. . . . . .
Brownberry. . . . . . . . . . . . . .
Mrs. Cubbison’s . . . . . . . . . .
Pepperidge Farm Stuffing. . .
Stove Top . . . . . . . . . . . . . . .
812
TOTAL:
00
OTHER (Write In)
00
01
02
03
04
05
06
07
08
02
03
04
05
06
07
08
09
10
11
12
13
14
15
999
BREAD CRUMBS &
COATING MIXES
14
15
999
Your Household:
Used in
Packages/
last 6
last 30
months
days
813
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Bread Crumbs . . . . . . . . . . .
Coatings . . . . . . . . . . . . . . . .
BRANDS:
Contadina . . . . . . . . . . . . . . .
4C. . . . . . . . . . . . . . . . . . . . .
Kellogg’s Corn Flake Crumbs
Kikkoman. . . . . . . . . . . . . . . .
Louisiana Fish Fry. . . . . . . . .
00
01
02
03
04
05
06
07
Oven Fry for Chicken . . . . . .
Oven Fry for Pork . . . . . . . . .
Progresso . . . . . . . . . . . . . . .
Shake ’N Bake Original for
Chicken. . . . . . . . . . . . . . .
Shake ’N Bake Original for
Pork . . . . . . . . . . . . . . . . .
08
09
10
11
12
Other Shake ’N Bake . . . . . . Zatarain’s . . . . . . . . . . . . . . . Store’s Own Brand . . . . . . . . 13
14
15
999
OTHER (Write In)
Your Household:
Used in
Packages/
last 6
last 30
months
days
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Boil In Bag . . . . . . . . . . . . . .
Instant . . . . . . . . . . . . . . . . .
Regular (Long Cooking) . . . .
KINDS:
Brown . . . . . . . . . . . . . . . . . .
White . . . . . . . . . . . . . . . . . .
BRANDS:
Blue Ribbon . . . . . . . . . . . . .
Canilla . . . . . . . . . . . . . . . . .
Carolina . . . . . . . . . . . . . . . .
Goya. . . . . . . . . . . . . . . . . . .
00
02
Mahatma Brown . . . . . . . . . .
Mahatma White . . . . . . . . . .
Other Mahatma . . . . . . . . . .
Minute Instant Brown . . . . . .
Minute Original . . . . . . . . . . .
Minute Multi-Grain Medley . .
Minute Premium. . . . . . . . . . .
Riceland . . . . . . . . . . . . . . . .
Success Boil-in-Bag . . . . . . .
Texmati . . . . . . . . . . . . . . . . .
Uncle Ben’s Boil-in-Bag . . . .
Uncle Ben’s Instant Brown
Rice . . . . . . . . . . . . . . . . .
Uncle Ben’s Instant Rice . . .
Uncle Ben’s Whole Grain
Brown Rice . . . . . . . . . . . .
Uncle Ben’s Original
Converted . . . . . . . . . . . . .
01
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
Store’s Own Brand . . . . . . . . 25
999
OTHER (Write In)
09
10
11
12
13
00
01
RICE
815
814
Kraft Pasta Salad . . . . . . . . .
La Choy . . . . . . . . . . . . . . . .
Nissin Chow Mein. . . . . . . . .
Pasta Roni . . . . . . . . . . . . . .
Velveeta Shells & Cheese . .
PACKAGED INSTANT
POTATOES
Your Household:
Used in
Packages/
last 6
last 30
months
days
841
................. TOTAL:
DINNER MIXES
AND KITS
FLAVORED &
SEASONED RICE
Your Household:
Used in
Packages/
last 6
last 30
months
days
816
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Goya. . . . . . . . . . . . . . . . . . .
Knorr Rice Sides . . . . . . . . .
Mahatma Rice Mixes . . . . . . .
Minute Ready to Serve. . . . . .
Near East . . . . . . . . . . . . . . .
Rice-A-Roni . . . . . . . . . . . . .
Uncle Ben’s Country Inn. . . .
Uncle Ben’s Long Grain
& Wild Rice . . . . . . . . . . . .
Uncle Ben’s Ready Rice . . . .
Other Uncle Ben’s . . . . . . . .
Vigo . . . . . . . . . . . . . . . . . . . Zatarain’s . . . . . . . . . . . . . . . Store’s Own Brand . . . . . . . . OTHER (Write In)
00
01
02
03
04
05
06
07
08
09
10
11
12
13
999
FOOD
Page 101
FROZEN/
REFRIGERATED
POTATO PRODUCTS
Your Household:
Used in
Packages/
last 6
last 30
months
days
FROZEN MAIN
COURSES
(Entrees or Casseroles)
818
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
French Fried Potatoes . . . . .
Mashed Potatoes . . . . . . . . .
Other Potatoes . . . . . . . . . . .
BRANDS:
Alexia . . . . . . . . . . . . . . . . . .
Birds Eye . . . . . . . . . . . . . . .
Bob Evans . . . . . . . . . . . . . .
Hormel Country Crock . . . . .
Larry’s Mashed Potatoes . . .
McCain French Fries . . . . . .
Other McCain . . . . . . . . . . . .
Ore-Ida Easy Fries . . . . . . . .
Ore-Ida Frozen French Fries .
Ore-Ida Frozen Hash Browns
Ore-Ida Frozen Tater Tots . . .
Ore-Ida Roasted. . . . . . . . . .
Ore-Ida Steam n’ Mash. . . . .
Other Ore-Ida . . . . . . . . . . . .
Simply Potatoes . . . . . . . . . .
OTHER (Write In)
FROZEN
VEGETABLES
Your Household:
Used in
Packages/
last 6
last 30
months
days
TOTAL:
................. 00
01
TYPES:
Low Calorie . . . . . . . . . . . . . Regular. . . . . . . . . . . . . . . . . 01
02
KINDS:
Single Serving . . . . . . . . . . . Family Size . . . . . . . . . . . . . . 03
04
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
999
Your Household:
Used in
Packages/
last 6
last 30
months
days
BRANDS:
Amy’s . . . . . . . . . . . . . . . . . .
Banquet . . . . . . . . . . . . . . . .
Gorton’s . . . . . . . . . . . . . . . .
Healthy Choice . . . . . . . . . . .
Hot Pockets . . . . . . . . . . . . .
Hot Pockets Croissant Crust .
Kashi . . . . . . . . . . . . . . . . . .
Lean Cuisine Entrees . . . . . .
Lean Pockets . . . . . . . . . . . .
Marie Callender’s . . . . . . . . .
Michelina’s . . . . . . . . . . . . . .
Newman’s Own . . . . . . . . . .
On-Cor . . . . . . . . . . . . . . . . .
Smucker’s Uncrustables. . . .
Stouffer’s Entrees . . . . . . . . .
Swanson Pot Pies . . . . . . . .
Tyson . . . . . . . . . . . . . . . . . .
Ones . . . . . . . . . . . . . . . . .
819
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Box . . . . . . . . . . . . . . . . . . . .
Plastic Bag . . . . . . . . . . . . . .
KINDS:
Plain . . . . . . . . . . . . . . . . . . .
With Sauce/Seasoning . . . . .
FORMS:
Single Vegetable. . . . . . . . . .
Mixed Vegetables . . . . . . . . .
BRANDS:
Birds Eye . . . . . . . . . . . . . . .
Cascadian Farm . . . . . . . . . .
Flav-R-Pac . . . . . . . . . . . . . .
Freshlike . . . . . . . . . . . . . . . .
Green Giant . . . . . . . . . . . . .
Goya. . . . . . . . . . . . . . . . . . .
Hanover . . . . . . . . . . . . . . . .
Libby’s . . . . . . . . . . . . . . . . .
Pictsweet . . . . . . . . . . . . . . .
OTHER (Write In)
GRAVY/SAUCE
MIXES AND
COOKING SAUCES
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
999
Your Household:
Used in Packages or
last 6
containers/
months
last 30 days
842
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Dry gravy mixes . . . . . . . . . .
Liquid gravy (ready to heat) .
Other sauce mixes . . . . . . . .
BRANDS:
Campbell’s . . . . . . . . . . . . . .
Durkee . . . . . . . . . . . . . . . . .
Gravy Master . . . . . . . . . . . .
Heinz . . . . . . . . . . . . . . . . . .
Knorr . . . . . . . . . . . . . . . . . .
Lawry’s . . . . . . . . . . . . . . . . .
McCormick . . . . . . . . . . . . . .
Pioneer. . . . . . . . . . . . . . . . .
OTHER (Write In)
00
01
02
03
04
05
06
07
08
09
10
11
12
999
OTHER (Write In)
FROZEN PIZZA
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
999
Your Household:
Used in
Packages/
last 6
last 30
months
days
824
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
California Pizza Kitchen . . . .
Celeste Pizza For One . . . . .
DiGiorno Rising Crust Pizza
DiGiorno Stuffed Crust Pizza
Other DiGiorno . . . . . . . . . . .
00
01
02
03
04
05
Ellio’s . . . . . . . . . . . . . . . . . .
Freschetta. . . . . . . . . . . . . . .
Home Run Inn . . . . . . . . . . .
Jack’s . . . . . . . . . . . . . . . . . .
Lean Cuisine . . . . . . . . . . . .
06
07
08
09
10
Newman’s Own. . . . . . . . . . .
Palermo’s . . . . . . . . . . . . . . .
Red Baron Deep Dish
Singles . . . . . . . . . . . . . . .
Red Baron Classic Crust . . .
Stouffer’s French Bread Pizza
11
12
13
14
15
Tombstone Original . . . . . . .
Tony’s . . . . . . . . . . . . . . . . . .
Tony’s Deep Dish . . . . . . . . .
Totino’s Party Pizza . . . . . . .
OTHER (Write In)
VEGETARIAN
FROZEN BURGERS
984
TOTAL: . . . . . . . . . . . . . . . . . TYPES:
Low Calorie . . . . . . . . . . . . . Regular. . . . . . . . . . . . . . . . . 16
17
18
19
20
999
00
01
02
03
04
999
00
01
02
KINDS:
Single Serving . . . . . . . . . . .
Family Size . . . . . . . . . . . . . .
BRANDS:
Banquet . . . . . . . . . . . . . . . .
Bertolli . . . . . . . . . . . . . . . . .
Birds Eye Voila! . . . . . . . . . .
Boston Market Frozen Meal
Buitoni . . . . . . . . . . . . . . . . .
03
04
05
06
07
08
09
Healthy Choice Complete
Meals . . . . . . . . . . . . . . . .
Hungry-Man . . . . . . . . . . . . .
Kid Cuisine . . . . . . . . . . . . . .
Lean Cuisine . . . . . . . . . . . .
Marie Callender’s . . . . . . . . .
10
11
12
13
14
15
16
Michelina’s . . . . . . . . . . . . . .
Stouffer’s Dinners . . . . . . . . .
Ones . . . . . . . . . . . . . . . . .
OTHER (Write In)
FROZEN HOT
SNACKS
17
18
999
Your Household:
Used in
Packages/
last 6
last 30
months
days
822
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Bagel Bites . . . . . . . . . . . . . .
Farm Rich Cheese Sticks. . .
Other Farm Rich Snacks . . .
Poppers . . . . . . . . . . . . . . . .
SuperPretzel. . . . . . . . . . . . .
00
01
02
03
04
05
T.G.I. Friday’s . . . . . . . . . . . .
Totino’s Pizza Rolls. . . . . . . .
White Castle Hamburgers. . .
OTHER (Write In)
REFRIGERATED
MEALS, ENTREES,
SNACKS & SIDES
06
07
08
09
999
Your Household:
Used in
Packages/
last 6
last 30
months
days
825
TOTAL:
Your Household:
Used in
Packages/
last 6
last 30
months
days
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Boca Burger . . . . . . . . . . . . .
Gardenburger . . . . . . . . . . . .
Lightlife . . . . . . . . . . . . . . . . .
Morningstar Farms . . . . . . . .
OTHER (Write In)
Your Household:
Used in
Number/
last 6
last 30
months
days
823
821
00
02
FROZEN COMPLETE
DINNERS
................. BRANDS:
Hormel Country Crock
Side Dishes (Non-Potato) . .
Hormel Entrees . . . . . . . . . .
Hormel Rev . . . . . . . . . . . . .
John Soules Foods. . . . . . . .
Lloyd’s Barbecue . . . . . . . . .
Perdue . . . . . . . . . . . . . . . . . Tyson . . . . . . . . . . . . . . . . . . OTHER (Write In)
00
01
02
03
04
05
06
07
999
FOOD
Page 102
FISH & SEAFOOD
FRESH OR FROZEN
Your Household:
Used in
Pounds
last 6
last 30
months
days
FROZEN BREADED
CHICKEN
828
826
TOTAL:
................. TYPES:
Crab . . . . . . . . . . . . . . . . . . .
Coated/Breaded Fillets . . . . .
Raw Fillets . . . . . . . . . . . . . .
Fish Sticks . . . . . . . . . . . . . .
Lobster Tails . . . . . . . . . . . . .
Scallops . . . . . . . . . . . . . . . .
Shrimp (Breaded). . . . . . . . .
Shrimp (Raw) . . . . . . . . . . . .
(Imitation Seafood) Surimi . .
00
01
02
03
04
05
06
07
08
09
FORMS:
Fresh . . . . . . . . . . . . . . . . . . Frozen . . . . . . . . . . . . . . . . . BRANDS:
Gorton’s . . . . . . . . . . . . . . . .
Louis Kemp . . . . . . . . . . . . .
Mrs. Paul’s . . . . . . . . . . . . . .
SeaPak. . . . . . . . . . . . . . . . .
Van de Kamp’s . . . . . . . . . . .
OTHER (Write In)
CHICKEN &
TURKEY FRESH
OR FROZEN
10
12
TYPES:
Chicken Breast (Fresh). . . . .
Chicken Breast (Frozen). . . .
Chicken Breasts
(Fully Cooked). . . . . . . . . .
Chicken Strips
(Fully Cooked). . . . . . . . . .
Chicken Whole (Fresh) . . . . .
Chicken Whole (Frozen) . . . .
Chicken Wings Fully
Cooked (Frozen) . . . . . . . .
Other Chicken (Fresh) . . . . .
Other Chicken (Frozen) . . . .
Cornish Hen (Fresh). . . . . . .
14
15
16
17
999
02
03
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Lean . . . . . . . . . . . . . . . . . . .
Regular. . . . . . . . . . . . . . . . .
FORMS:
Fresh . . . . . . . . . . . . . . . . . .
Frozen . . . . . . . . . . . . . . . . .
KINDS:
Ground Beef . . . . . . . . . . . . .
Steaks . . . . . . . . . . . . . . . . .
Roasts . . . . . . . . . . . . . . . . .
01
05
06
07
08
09
10
14
Turkey Whole (Fresh) . . . . . .
Turkey Whole (Frozen) . . . . .
Other Fresh Turkey . . . . . . . .
Other Frozen Turkey . . . . . . .
Jennie-O Turkey Store . . . . .
Nature Raised Farms . . . . . .
Perdue . . . . . . . . . . . . . . . . .
Pilgrim’s . . . . . . . . . . . . . . . .
Sanderson Farms. . . . . . . . .
Shady Brook Farms . . . . . . .
Tender Bird . . . . . . . . . . . . . .
Tyson . . . . . . . . . . . . . . . . . .
01
02
03
04
05
06
07
08
09
10
999
OTHER MEAT
FRESH/FROZEN
00
01
02
03
04
05
06
07
999
00
02
Eckrich . . . . . . . . . . . . . . . . .
Farmer John . . . . . . . . . . . . .
Farmland . . . . . . . . . . . . . . .
Gwaltney . . . . . . . . . . . . . . .
Hormel Black Label . . . . . . .
Hormel Microwave Ready . .
Other Hormel Bacon . . . . . .
Jennie-O Turkey Bacon . . . .
Jimmy Dean . . . . . . . . . . . . .
Oscar Mayer. . . . . . . . . . . . .
Plumrose . . . . . . . . . . . . . . .
Smithfield . . . . . . . . . . . . . . .
Thorn Apple Valley . . . . . . . .
Tyson . . . . . . . . . . . . . . . . . .
Wright . . . . . . . . . . . . . . . . . .
11
13
OTHER (Write In)
15
16
17
COOKED HAMS
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
999
CANNED MEATS
00
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
999
Your Household:
Used in
Cans/
last 6
last 30
months
days
840
02
03
04
01
05
06
07
08
09
999
831
OTHER (Write In)
03
OTHER (Write In)
Your Household:
Used in
Packages/
last 6
last 30
months
days
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Canned. . . . . . . . . . . . . . . . .
Wrapped . . . . . . . . . . . . . . . .
KINDS:
Low Salt . . . . . . . . . . . . . . . .
Regular. . . . . . . . . . . . . . . . .
BRANDS:
Cook’s . . . . . . . . . . . . . . . . .
Farmland . . . . . . . . . . . . . . .
Hillshire Farm . . . . . . . . . . . .
HoneyBaked. . . . . . . . . . . . .
Hormel . . . . . . . . . . . . . . . . .
Hormel Cure 81 . . . . . . . . . .
Plumrose . . . . . . . . . . . . . . .
Smithfield . . . . . . . . . . . . . . .
01
Store’s Own Brand . . . . . . . . Your Household:
Used in
Pounds/
last 6
last 30
months
days
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Lean . . . . . . . . . . . . . . . . . . .
Regular. . . . . . . . . . . . . . . . .
FORMS:
Fresh . . . . . . . . . . . . . . . . . .
Frozen . . . . . . . . . . . . . . . . .
KINDS:
Lamb . . . . . . . . . . . . . . . . . .
Pork (Chops) . . . . . . . . . . . .
Pork (Roasts) . . . . . . . . . . . .
Other Pork . . . . . . . . . . . . . .
Veal. . . . . . . . . . . . . . . . . . . .
Your Household:
Used in
Pounds/
last 6
last 30
months
days
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Low Sodium . . . . . . . . . . . . .
Regular. . . . . . . . . . . . . . . . .
Thick Cut . . . . . . . . . . . . . . .
KINDS:
Regular (Ready to Cook) . . .
Microwaveable . . . . . . . . . . .
Fully Cooked. . . . . . . . . . . . .
BRANDS:
Applegate . . . . . . . . . . . . . . .
Armour . . . . . . . . . . . . . . . . .
Bar S . . . . . . . . . . . . . . . . . .
Butterball Turkey Bacon . . . .
Corn King . . . . . . . . . . . . . . .
830
04
12
829
OTHER (Write In)
OTHER (Write In)
BEEF
FRESH/FROZEN
00
BACON AND
BREAKFAST STRIPS
834
Your Household:
Used in
Pounds/
last 6
last 30
months
days
00
Cornish Hen (Frozen) . . . . . .
Turkey Boneless (Fresh). . . .
Turkey Boneless (Frozen). . .
Turkey Breast (Fresh—
Bone In) . . . . . . . . . . . . . .
Turkey Breast (Frozen—
Bone In) . . . . . . . . . . . . . .
BRANDS:
Butterball Turkey . . . . . . . . . .
Country Pride . . . . . . . . . . . .
Foster Farms . . . . . . . . . . . .
Gold’n Plump . . . . . . . . . . . .
Honeysuckle White Turkey . .
OTHER (Write In)
13
Your Household:
Used in
Pounds
last 6
last 30
months
days
................. TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Banquet Crispy Chicken. . . .
Banquet Patties . . . . . . . . . .
Banquet Tenders, Nuggets,
Wings . . . . . . . . . . . . . . . .
Barber Foods . . . . . . . . . . . .
Foster Farms . . . . . . . . . . . .
Perdue Nuggets . . . . . . . . . .
Tyson Any’tizers . . . . . . . . . .
Tyson Breast Patties . . . . . . .
Other Tyson . . . . . . . . . . . . .
Weaver . . . . . . . . . . . . . . . . .
11
827
TOTAL:
Your Household:
Used in
Packages/
last 6
last 30
months
days
00
01
02
03
04
05
06
07
08
09
10
11
12
999
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Hormel . . . . . . . . . . . . . . . .
Libby’s Corned Beef. . . . . . .
SPAM . . . . . . . . . . . . . . . . . .
Treet . . . . . . . . . . . . . . . . . . .
OTHER (Write In)
CANNED CHICKEN
00
01
02
03
04
05
999
Your Household:
Used in
Cans/
last 6
last 30
months
days
807
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Hormel . . . . . . . . . . . . . . . . .
Swanson. . . . . . . . . . . . . . . .
Valley Fresh . . . . . . . . . . . . .
OTHER (Write In)
BRATWURST
00
01
02
03
04
999
Your Household:
Used in
Pounds/
last 6
last 30
months
days
832
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Hillshire Farm . . . . . . . . . . . .
Johnsonville . . . . . . . . . . . . .
OTHER (Write In)
00
01
02
03
999
FOOD
Page 103
FRANKFURTERS &
HOT DOGS
Your Household:
Used in
Packages/
last 6
last 30
months
days
836
TOTAL:
00
TYPES:
Beef . . . . . . . . . . . . . . . . . . .
Chicken . . . . . . . . . . . . . . . .
Turkey . . . . . . . . . . . . . . . . . .
Other meats . . . . . . . . . . . . .
01
02
03
04
KINDS:
Fat Free . . . . . . . . . . . . . . . .
Light/Reduced Fat . . . . . . . .
Low Sodium . . . . . . . . . . . . .
Regular. . . . . . . . . . . . . . . . .
05
06
07
08
BRANDS:
Applegate . . . . . . . . . . . . . .
Armour . . . . . . . . . . . . . . . . .
Ball Park . . . . . . . . . . . . . . . .
Bar S . . . . . . . . . . . . . . . . . .
Bryan . . . . . . . . . . . . . . . . . .
Eckrich . . . . . . . . . . . . . . . . .
Farmer John . . . . . . . . . . . . .
Gwaltney . . . . . . . . . . . . . . .
Hebrew National. . . . . . . . . .
Hillshire Farms . . . . . . . . . . .
Jennie-O Turkey Franks . . . .
John Morrell . . . . . . . . . . . . .
Kahn’s. . . . . . . . . . . . . . . . . .
Nathan’s . . . . . . . . . . . . . . . .
Oscar Mayer (Regular) . . . . .
Oscar Mayer Selects . . . . . .
OTHER (Write In)
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
999
Your Household:
Used in
Pounds/
last 6
last 30
months
days
837
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Breakfast . . . . . . . . . . . . . . .
Dinner. . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . .
FORMS:
Link. . . . . . . . . . . . . . . . . . . .
Patties. . . . . . . . . . . . . . . . . .
Roll . . . . . . . . . . . . . . . . . . . .
KINDS:
Smoked . . . . . . . . . . . . . . . .
Non-Smoked . . . . . . . . . . . .
BRANDS:
Aidells. . . . . . . . . . . . . . . . . .
Al Fresco . . . . . . . . . . . . . . .
Armour . . . . . . . . . . . . . . . . .
Banquet Brown ’N Serve . . .
Bar S . . . . . . . . . . . . . . . . . .
Bob Evans . . . . . . . . . . . . . .
Bryan . . . . . . . . . . . . . . . . . .
Butterball . . . . . . . . . . . . . . .
Eckrich . . . . . . . . . . . . . . . . .
Farmer John . . . . . . . . . . . . .
Farmland . . . . . . . . . . . . . . .
Hillshire Farm . . . . . . . . . . . .
Hormel Little Sizzlers . . . . . .
Jennie-O Turkey Sausage . .
Jimmy Dean . . . . . . . . . . . . .
John Morrell . . . . . . . . . . . . .
Johnsonville . . . . . . . . . . . . .
Oscar Mayer. . . . . . . . . . . . .
Owens . . . . . . . . . . . . . . . . .
Premio . . . . . . . . . . . . . . . . .
Tennessee Pride. . . . . . . . . .
OTHER (Write In)
Your Household:
Used in
Pounds/
last 6
last 30
months
days
MEAT SNACKS
00
02
03
04
05
06
01
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Fat Free . . . . . . . . . . . . . . . .
Low Fat. . . . . . . . . . . . . . . . .
Low Sodium . . . . . . . . . . . . .
Regular. . . . . . . . . . . . . . . . .
KINDS:
Bologna . . . . . . . . . . . . . . . .
Chicken Cold Cuts . . . . . . . .
Ham . . . . . . . . . . . . . . . . . . .
Roast Beef . . . . . . . . . . . . . .
Salami/Summer Sausage. . .
Turkey Bologna. . . . . . . . . . .
Turkey Breast . . . . . . . . . . . .
Turkey Ham . . . . . . . . . . . . .
Other Red Meat Cold Cuts . .
Other Turkey Cold Cuts . . . .
FORMS:
Packaged . . . . . . . . . . . . . . .
Fresh cut/Deli . . . . . . . . . . . .
BRANDS:
Armour . . . . . . . . . . . . . . . . .
Bar S . . . . . . . . . . . . . . . . . .
Boar’s Head . . . . . . . . . . . . .
Bryan . . . . . . . . . . . . . . . . . .
Buddig . . . . . . . . . . . . . . . . .
Butterball . . . . . . . . . . . . . . .
Dietz & Watson. . . . . . . . . . .
Eckrich . . . . . . . . . . . . . . . . .
Farmland . . . . . . . . . . . . . . .
Gallo. . . . . . . . . . . . . . . . . . .
Gwaltney . . . . . . . . . . . . . . .
Healthy Ones . . . . . . . . . . . .
Hillshire Farm/Deli Select . . .
Hormel . . . . . . . . . . . . . . . . .
Hormel Natural Choice. . . . .
Jennie-O. . . . . . . . . . . . . . . .
Land O’Frost. . . . . . . . . . . . .
Oscar Mayer Deli Fresh . . . .
Other Oscar Mayer. . . . . . . .
Sara Lee. . . . . . . . . . . . . . . .
OTHER (Write In)
MUSTARD
07
08
Your Household:
Used in
Packages/
last 6
last 30
months
days
833
838
................. SAUSAGE
COLD CUTS
00
01
02
03
04
05
06
07
08
09
10
11
12
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Jerky. . . . . . . . . . . . . . . . . . .
Meat Sticks. . . . . . . . . . . . . .
KINDS:
Beef . . . . . . . . . . . . . . . . . . .
Pepperoni . . . . . . . . . . . . . . .
Salami . . . . . . . . . . . . . . . . .
BRANDS:
Jack Link’s . . . . . . . . . . . . . .
Krave . . . . . . . . . . . . . . . . . .
Oberto . . . . . . . . . . . . . . . . .
Slim Jim . . . . . . . . . . . . . . . .
OTHER (Write In)
13
14
PICKLES
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
999
Your Household:
Jars or
Used in
squeeze
last 6
bottles/last
months
3 months
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
999
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Brown/Spicy . . . . . . . . . . . . .
Dijon . . . . . . . . . . . . . . . . . . .
Dijonnaise . . . . . . . . . . . . . .
Honey . . . . . . . . . . . . . . . . . .
Yellow . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . .
BRANDS:
Best Foods . . . . . . . . . . . . . .
French’s Classic Yellow. . . . .
Other French’s . . . . . . . . . . .
Grey Poupon Dijon . . . . . . . .
Other Grey Poupon . . . . . . . .
Gulden’s . . . . . . . . . . . . . . . .
Heinz . . . . . . . . . . . . . . . . . .
Hellmann’s . . . . . . . . . . . . . .
Jack Daniel’s . . . . . . . . . . . .
Koops . . . . . . . . . . . . . . . . . .
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
Plochman’s Premium . . . . . . Store’s Own Brand . . . . . . . . OTHER (Write In)
17
18
999
00
01
02
03
04
05
06
07
08
09
10
999
Your Household:
Used in
Jars/
last 6
last 30
months
days
849
00
01
02
03
04
05
06
07
08
09
10
11
12
Store’s Own Brand . . . . . . . . 999
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Dill (Refrigerated in store). . .
Dill (Shelf in store) . . . . . . . .
Low Salt . . . . . . . . . . . . . . . .
Sweet . . . . . . . . . . . . . . . . . .
KINDS:
Slices . . . . . . . . . . . . . . . . . .
Spears . . . . . . . . . . . . . . . . .
Whole . . . . . . . . . . . . . . . . . .
BRANDS:
Claussen . . . . . . . . . . . . . . .
Del Monte . . . . . . . . . . . . . . .
Heinz . . . . . . . . . . . . . . . . . .
Mt. Olive . . . . . . . . . . . . . . . .
Vlasic . . . . . . . . . . . . . . . . . .
13
OTHER (Write In)
PICKLE RELISH
Your Household:
Used in
Bottles or
last 6
jars/last
months
3 months
850
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Del Monte . . . . . . . . . . . . . . .
Heinz . . . . . . . . . . . . . . . . . .
Mt. Olive . . . . . . . . . . . . . . . .
Vlasic . . . . . . . . . . . . . . . . . .
843
OTHER (Write In)
VINEGAR
01
02
03
04
05
999
Your Household:
Used in
Bottles/
last 6
last 30
months
days
854
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Balsamic. . . . . . . . . . . . . . . .
Cider. . . . . . . . . . . . . . . . . . .
Rice . . . . . . . . . . . . . . . . . . .
White Distilled. . . . . . . . . . . .
Wine . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . .
BRANDS:
Heinz . . . . . . . . . . . . . . . . . .
Nakano . . . . . . . . . . . . . . . . .
Pompeian . . . . . . . . . . . . . . .
Progresso . . . . . . . . . . . . . . .
Regina . . . . . . . . . . . . . . . . .
00
01
02
03
04
05
06
07
08
09
10
11
Star. . . . . . . . . . . . . . . . . . . . White House . . . . . . . . . . . . . Store’s Own Brand . . . . . . . . OTHER (Write In)
00
12
13
14
999
FOOD
Page 104
SALAD OR
COOKING OIL
Your Household:
Used in
Pints/
last 6
last 30
months
days
SALAD DRESSING
855
TOTAL:
858
................. TYPES:
Canola Oil. . . . . . . . . . . . . . .
Corn Oil . . . . . . . . . . . . . . . .
Olive Oil . . . . . . . . . . . . . . . .
Peanut Oil. . . . . . . . . . . . . . .
Safflower Oil . . . . . . . . . . . . .
Sunflower Oil . . . . . . . . . . . . Vegetable Oil . . . . . . . . . . . . Other . . . . . . . . . . . . . . . . . . BRANDS:
Bertolli . . . . . . . . . . . . . . . . .
Carapelli . . . . . . . . . . . . . . . .
Colavita . . . . . . . . . . . . . . . .
Crisco Blends . . . . . . . . . . . .
Crisco Pure Canola . . . . . . .
Crisco Vegetable Oil . . . . . . .
Other Crisco . . . . . . . . . . . . .
Filippo Berio . . . . . . . . . . . . .
Goya. . . . . . . . . . . . . . . . . . .
LouAna. . . . . . . . . . . . . . . . .
Mazola . . . . . . . . . . . . . . . . .
Pompeian . . . . . . . . . . . . . . .
Wesson Best Blend . . . . . . .
Wesson Vegetable Oil . . . . .
OTHER (Write In)
Used for:
Baking . . . . . . . . . . . . . . . . .
Frying . . . . . . . . . . . . . . . . . .
Salad . . . . . . . . . . . . . . . . . .
Sautéing/Stir Frying . . . . . . .
Other . . . . . . . . . . . . . . . . . .
MAYONNAISE AND
MAYONNAISE TYPE
SPREAD/ DRESSING
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
999
856-0
1
2
3
4
5
Your Household:
Used in
Jars/
last 6
last 30
months
days
857
................. 00
TYPES:
Low Fat. . . . . . . . . . . . . . . . . Fat Free . . . . . . . . . . . . . . . . Regular. . . . . . . . . . . . . . . . . 01
02
03
KINDS:
Jar . . . . . . . . . . . . . . . . . . . . Squeeze . . . . . . . . . . . . . . . . 04
05
TOTAL:
BRANDS:
Best Foods Light . . . . . . . . .
Best Foods Real
Mayonnaise . . . . . . . . . . .
Best Foods w/ Olive Oil . . . .
Blue Plate . . . . . . . . . . . . . . .
Duke’s. . . . . . . . . . . . . . . . . .
Hellmann’s Light . . . . . . . . . .
Hellmann’s Real
Mayonnaise . . . . . . . . . . .
Hellmann’s Low Fat . . . . . . .
Hellmann’s w/Olive Oil . . . . .
Other Hellmann’s . . . . . . . . .
Kraft Real Mayonnaise . . . . .
Kraft Fat Free Mayonnaise . .
Kraft Light Mayonnaise. . . . .
Kraft Miracle Whip Fat Free .
Kraft Miracle Whip Light . . . .
Kraft Miracle Whip (Regular)
Kraft Sandwich Shop Mayo .
Other Kraft . . . . . . . . . . . . . .
OTHER (Write In)
Your Household:
Used in
Bottles or
last 6
packages/
months
last 30 days
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
00
01
02
03
04
05
06
BRANDS:
Briannas . . . . . . . . . . . . . . . . Girard’s . . . . . . . . . . . . . . . . . Good Seasons . . . . . . . . . . . Hidden Valley Farmhouse
Originals . . . . . . . . . . . . . . Hidden Valley Ranch Regular
Bottled. . . . . . . . . . . . . . . . Hidden Valley Ranch
Fat Free Bottled . . . . . . . . Hidden Valley Ranch Light
Bottled. . . . . . . . . . . . . . . . Hidden Valley Ranch Dry Mix Ken’s. . . . . . . . . . . . . . . . . . . Kraft Free . . . . . . . . . . . . . . . Kraft Light . . . . . . . . . . . . . . . Kraft (Regular) . . . . . . . . . . . Litehouse . . . . . . . . . . . . . . . Marie’s . . . . . . . . . . . . . . . . . Marzetti. . . . . . . . . . . . . . . . . Newman’s Own. . . . . . . . . . . Newman’s Own Lite . . . . . . . Western Salad Dressing. . . . Wish-Bone Fat Free . . . . . . . Wish-Bone Light . . . . . . . . . . Wish-Bone (Regular) . . . . . . Store’s Own Brand . . . . . . . . 07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
999
OTHER (Write In)
Your Household:
Used in
Bottles or
last 6
packages/
months
last 30 days
853
00
01
02
03
04
05
06
07
08
09
10
Store’s Own Brand . . . . . . . . 999
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
BacÕs . . . . . . . . . . . . . . . . .
French’s French Fried Onions
Hormel Real Bacon Bits . . . .
Hormel Real Bacon Pieces .
McCormick Bac’n Pieces . . .
Mrs. Cubbison’s Croutons. . .
New York Texas Toast
Croutons . . . . . . . . . . . . . .
Oscar Mayer Real Bacon
Bits . . . . . . . . . . . . . . . . . .
Pepperidge Farm Croutons . .
Salad Crispins . . . . . . . . . . .
OTHER (Write In)
Your Household:
Used in
Packages/
last 6
last 30
months
days
996
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Fat Free . . . . . . . . . . . . . . . .
Low Fat/Light . . . . . . . . . . . .
Regular. . . . . . . . . . . . . . . . .
KINDS:
Dry Mix . . . . . . . . . . . . . . . . .
Bottle (Shelf in store) . . . . . .
Bottle (Refrigerated in store)
FLAVORS:
Bacon . . . . . . . . . . . . . . . . . .
Buttermilk . . . . . . . . . . . . . . .
Caesar/Creamy Caesar . . . .
Creamy Cucumber . . . . . . . .
Dijon/Mustard . . . . . . . . . . . .
French . . . . . . . . . . . . . . . . .
Italian/Creamy Italian . . . . . .
Oil & Vinegar . . . . . . . . . . . .
Ranch. . . . . . . . . . . . . . . . . .
Roquefort/Blue Cheese . . . .
1000 Island/Russian. . . . . . .
Vinaigrette. . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . .
SALAD TOPPINGS
PACKAGED
FRESH SALAD
11
00
01
02
03
04
05
Store’s Own Brand . . . . . . . . 06
999
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Dole . . . . . . . . . . . . . . . . . . .
Earthbound Farm . . . . . . . . .
Fresh Express . . . . . . . . . . .
Ready Pac . . . . . . . . . . . . . .
Taylor Farms. . . . . . . . . . . . .
OTHER (Write In)
FRESH FRUIT &
VEGETABLES
Your Household:
Used in
Pounds/
last 6
last 30
months
days
861
TOTAL: . . . . . . . . . . . . . . . . .
KINDS:
Organic. . . . . . . . . . . . . . . . .
Non-organic . . . . . . . . . . . . .
TYPES:
Apples . . . . . . . . . . . . . . . . .
Apricots . . . . . . . . . . . . . . . .
Asparagus . . . . . . . . . . . . . .
Avocados . . . . . . . . . . . . . . .
Bananas . . . . . . . . . . . . . . . .
00
01
02
Broccoli. . . . . . . . . . . . . . . . .
Cabbage. . . . . . . . . . . . . . . .
Cantaloupes . . . . . . . . . . . . .
Carrots . . . . . . . . . . . . . . . . .
Cauliflower . . . . . . . . . . . . . .
Cherries . . . . . . . . . . . . . . . .
Corn . . . . . . . . . . . . . . . . . . .
Cucumber. . . . . . . . . . . . . . .
Grapefruit . . . . . . . . . . . . . . .
Grapes . . . . . . . . . . . . . . . . .
Green Beans . . . . . . . . . . . .
Kale . . . . . . . . . . . . . . . . . . .
Kiwi. . . . . . . . . . . . . . . . . . . .
Lemons . . . . . . . . . . . . . . . .
Lettuce . . . . . . . . . . . . . . . . .
Limes . . . . . . . . . . . . . . . . . .
Mushrooms. . . . . . . . . . . . . .
Onions . . . . . . . . . . . . . . . . .
Oranges . . . . . . . . . . . . . . . .
Peaches . . . . . . . . . . . . . . . .
Pears . . . . . . . . . . . . . . . . . .
Peas . . . . . . . . . . . . . . . . . . .
Peppers . . . . . . . . . . . . . . . .
Pineapples . . . . . . . . . . . . . .
Plums . . . . . . . . . . . . . . . . . .
Potatoes . . . . . . . . . . . . . . . .
Pumpkin . . . . . . . . . . . . . . . .
Raspberries . . . . . . . . . . . . .
Spinach . . . . . . . . . . . . . . . .
Strawberries . . . . . . . . . . . . .
Tomatoes . . . . . . . . . . . . . . . Watermelons . . . . . . . . . . . . 03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
999
OTHER (Write In)
FROZEN ORANGE
JUICE
Your Household:
Used in
Glasses/
last 6
average
months
day
862
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Minute Maid . . . . . . . . . . . . .
Old Orchard . . . . . . . . . . . . .
Tropicana . . . . . . . . . . . . . . .
999
OTHER (Write In)
00
01
02
03
04
999
FOOD
Page 105
ORANGE JUICE
NOT FROZEN
Your Household:
Used in
Glasses/
last 6
average
months
day
TOMATO AND
VEGETABLE JUICES
863
TOTAL:
................. TYPES:
Single Serving Bottles . . . . .
Single Serving Boxes . . . . . .
Bottled . . . . . . . . . . . . . . . . .
Canned. . . . . . . . . . . . . . . . .
Carton . . . . . . . . . . . . . . . . .
Plastic Jug . . . . . . . . . . . . . .
01
02
03
04
05
06
07
08
09
BRANDS:
Florida’s Natural . . . . . . . . . .
Minute Maid + Calcium. . . . .
Minute Maid Country Style . .
Minute Maid Heart Wise . . . .
Minute Maid Pure Squeezed
10
11
12
13
14
15
16
17
18
19
20
21
Tropicana Pure Premium Lots
of Pulp (Grovestand). . . . .
Tropicana Pure Premium
Some Pulp (Homestyle) . .
w/Calcium . . . . . . . . . . . . .
Other Tropicana . . . . . . . . . .
OTHER (Write In)
GRAPEFRUIT JUICE
22
23
24
999
Your Household:
Used in
Glasses/
last 6
average
months
day
864
TOTAL:
................. TYPES:
Bottled . . . . . . . . . . . . . . . . .
Canned. . . . . . . . . . . . . . . . .
Carton . . . . . . . . . . . . . . . . .
Frozen . . . . . . . . . . . . . . . . .
Plastic Jug . . . . . . . . . . . . . .
KINDS:
Pink/Ruby Red . . . . . . . . . . .
White/Golden . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . .
BRANDS:
Florida’s Natural Ruby Red .
Minute Maid . . . . . . . . . . . . .
Ocean Spray . . . . . . . . . . . .
R.W. Knudsen. . . . . . . . . . . .
Simply Grapefruit . . . . . . . . .
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
Ruby Red . . . . . . . . . . . . . Other Tropicana . . . . . . . . . . Store’s Own Brand . . . . . . . . 15
16
17
999
867
OTHER (Write In)
01
02
KINDS:
Low/Reduced Sodium . . . . . Regular. . . . . . . . . . . . . . . . . OTHER (Write In)
POWDERED FRUIT &
SOFT DRINKS
05
06
07
08
09
10
999
Your Household:
Used in
Glasses/
last 6
last 7
months
days
866
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Sweetened – Sugar . . . . . . .
Sweetened – Sugar-Free . . .
Unsweetened . . . . . . . . . . .
BRANDS:
Country Time Pink
Lemonade. . . . . . . . . . . . .
Country Time Lemonade . . .
Crystal Light . . . . . . . . . . . . .
Flavor Aid . . . . . . . . . . . . . . .
Gatorade . . . . . . . . . . . . . . .
Hawaiian Punch . . . . . . . . . .
Kool-Aid (sugar sweetened)
Kool-Aid (unsweetened) . . . .
Propel . . . . . . . . . . . . . . . . . .
Tang . . . . . . . . . . . . . . . . . . .
Wyler’s Light . . . . . . . . . . . . .
OTHER (Write In)
INSTANT
BREAKFAST
03
04
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
999
Your Household:
Used in
Packages/
last 6
Boxes last
months
30 days
762
TOTAL: . . . . . . . . . . . . . . . . . BRAND:
Carnation Breakfast
Essentials . . . . . . . . . . . . . Store’s Own Brand . . . . . . . . 00
01
02
999
DRIED FRUIT
Your Household:
Used in
Pounds/
last 6
last 6
months
months
859
Your Household:
Used in
Glasses/
last 6
last 7
months
days
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Goya. . . . . . . . . . . . . . . . . . .
Jumex. . . . . . . . . . . . . . . . . .
Kern’s . . . . . . . . . . . . . . . . . .
00
OTHER (Write In)
OTHER (Write In)
NECTARS
TOTAL: . . . . . . . . . . . . . . . . . TYPES:
Bottled . . . . . . . . . . . . . . . . . Canned. . . . . . . . . . . . . . . . . BRANDS:
Campbell’s Tomato Juice . . .
Clamato . . . . . . . . . . . . . . . .
Del Monte . . . . . . . . . . . . . . .
V8 (Original) . . . . . . . . . . . . .
V8 Spicy Hot. . . . . . . . . . . . .
00
01
02
03
999
TOTAL:
................. TYPES:
Apples . . . . . . . . . . . . . . . . .
Apricots . . . . . . . . . . . . . . . .
Bananas . . . . . . . . . . . . . . . .
Cranberries . . . . . . . . . . . . .
Dates . . . . . . . . . . . . . . . . . .
Figs. . . . . . . . . . . . . . . . . . . .
Prunes . . . . . . . . . . . . . . . . .
Raisins . . . . . . . . . . . . . . . . .
OTHER (Write In)
Used for:
860-0
Cooking . . . . . . . . . . . . . . . . 1
Snacks . . . . . . . . . . . . . . . . . 2
OTHER FRUIT
JUICES & DRINKS
Your Household:
Used in
Glasses/
last 6
average
months
day
868
865
00
KINDS:
Fresh Squeezed . . . . . . . . . . From Concentrate. . . . . . . . . Not From Concentrate . . . . . Minute Maid (Regular) . . . . .
Other Minute Maid . . . . . . . .
Simply Orange . . . . . . . . . . .
Trop50. . . . . . . . . . . . . . . . . .
No Pulp (Original) . . . . . . .
Your Household:
Used in
Glasses/
last 6
average
months
day
00
01
02
03
04
05
06
07
08
999
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Single Serving Boxes . . . . . .
Single Serving Cans. . . . . . .
Single Serving Pouches . . . .
Bottled . . . . . . . . . . . . . . . . .
00
01
02
03
04
05
Canned. . . . . . . . . . . . . . . . .
Carton . . . . . . . . . . . . . . . . .
FORMS:
Concentrate . . . . . . . . . . . . .
Frozen . . . . . . . . . . . . . . . . .
Liquid . . . . . . . . . . . . . . . . . .
KINDS:
Apple . . . . . . . . . . . . . . . . . .
Cherry . . . . . . . . . . . . . . . . .
Coconut Water . . . . . . . . . . .
Cranberry . . . . . . . . . . . . . . .
Fruit Punch . . . . . . . . . . . . . .
06
07
08
09
10
11
12
13
14
15
Grape . . . . . . . . . . . . . . . . . .
Lemonade/Pink Lemonade .
Lemon/Lime . . . . . . . . . . . . .
Orange . . . . . . . . . . . . . . . . .
Pineapple . . . . . . . . . . . . . . .
16
17
18
19
20
Pomegranate . . . . . . . . . . . .
Juice Blends . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . .
BRANDS:
Apple & Eve . . . . . . . . . . . . .
Bolthouse Farms . . . . . . . . .
Capri Sun (Ready to Drink) .
Crystal Light (liquid) . . . . . . .
Dole Pineapple Juice . . . . . .
Dole Blended Juices . . . . . . .
Fuze . . . . . . . . . . . . . . . . . . .
Hawaiian Punch . . . . . . . . . .
Hi-C . . . . . . . . . . . . . . . . . . .
Juicy Juice . . . . . . . . . . . . . .
Kool-Aid Bursts. . . . . . . . . . .
Kool-Aid Jammers . . . . . . . .
Minute Maid . . . . . . . . . . . . .
Minute Maid Coolers. . . . . . .
Minute Maid Light . . . . . . . . .
Mio Water Enhancer. . . . . . .
Mott’s . . . . . . . . . . . . . . . . . .
Naked . . . . . . . . . . . . . . . . . .
Newman’s Own. . . . . . . . . . .
Northland Cranberry . . . . . .
Ocean Spray Diet . . . . . . . . .
Ocean Spray Light . . . . . . . .
Ocean Spray 100% Juice . . .
Other Ocean Spray . . . . . . .
Odwalla . . . . . . . . . . . . . . . .
Old Orchard . . . . . . . . . . . . .
POM Wonderful . . . . . . . . . .
ReaLemon . . . . . . . . . . . . . .
R.W. Knudsen. . . . . . . . . . . .
Santa Cruz Organic . . . . . . .
Simply Lemonade. . . . . . . . .
Snapple . . . . . . . . . . . . . . . .
SoBe . . . . . . . . . . . . . . . . . .
SunnyD. . . . . . . . . . . . . . . . .
Sunsweet . . . . . . . . . . . . . . .
Tree Top . . . . . . . . . . . . . . . .
Trop50. . . . . . . . . . . . . . . . . .
Tropicana . . . . . . . . . . . . . . .
Tropicana Farmstand . . . . . .
Tropicana Twister . . . . . . . . .
V8 Splash . . . . . . . . . . . . . . .
V8 V-Fusion . . . . . . . . . . . . .
Vita Coco . . . . . . . . . . . . . . .
Welch’s Grape . . . . . . . . . . .
Other Welch’s . . . . . . . . . . . .
Zico . . . . . . . . . . . . . . . . . . .
21
22
23
OTHER (Write In)
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
999
FOOD
Page 106
DRINK ADDITIVES &
HOT COCOA
(Add milk or water)
Your Household:
Used in
Servings/
last 6
last 7
months
days
INSTANT ICED
TEA MIX
869
00
TYPES:
Sugar Free . . . . . . . . . . . . . . Regular. . . . . . . . . . . . . . . . . 01
02
KINDS:
Fat Free . . . . . . . . . . . . . . . . Regular. . . . . . . . . . . . . . . . . 03
04
FORMS:
Syrup . . . . . . . . . . . . . . . . . . Powder . . . . . . . . . . . . . . . . . 05
06
BRANDS:
Abuelita Hot Chocolate. . . . .
Land O’Lakes Cocoa
Classics . . . . . . . . . . . . . .
Nestlé Hot Cocoa
(Rich Chocolate) . . . . . . . .
Nestlé Hot Cocoa
(w/mini-marshmallows) . . .
Nestlé Fat Free Hot Cocoa . .
00
01
02
03
04
05
06
07
08
09
10
Lipton Iced Tea Mix. . . . . . . .
Lipton Tea & Honey . . . . . . .
Other Lipton . . . . . . . . . . . . .
Nestea . . . . . . . . . . . . . . . . .
11
12
13
14
15
999
07
08
09
10
11
Other Nestlé Hot Cocoa . . . .
Hershey’s Chocolate Syrup .
Nesquik Chocolate . . . . . . . .
Nesquik Strawberry . . . . . . .
Ovaltine (Rich Chocolate) . .
12
13
14
15
16
Other Ovaltine . . . . . . . . . . .
Swiss Miss Milk Chocolate
Hot Cocoa. . . . . . . . . . . . .
Other Swiss Miss Hot Cocoa
17
TOTAL:
................. 00
18
19
20
TYPES:
Regular. . . . . . . . . . . . . . . . . Decaffeinated . . . . . . . . . . . . 01
02
OTHER (Write In)
999
Your Household:
Used in
Containers/
last 6
last 30
months
days
870
TOTAL:
................. BRANDS:
Hershey’s . . . . . . . . . . . . . . . Nestlé . . . . . . . . . . . . . . . . . . Store’s Own Brand . . . . . . . . 00
01
02
03
999
OTHER (Write In)
SOY MILK & OTHER
PLANT/NUT MILKS
(Almond, Rice, etc.)
Your Household:
Used in
Glasses/
last 6
last 7
months
days
986
TOTAL:
................. TYPES:
Almond Milk . . . . . . . . . . . . .
Coconut Milk. . . . . . . . . . . . .
Rice Milk. . . . . . . . . . . . . . . .
Soy Milk . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . .
00
01
02
03
04
05
KINDS:
Regular. . . . . . . . . . . . . . . . .
Chocolate . . . . . . . . . . . . . . .
Vanilla. . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . .
06
07
08
09
BRANDS:
Blue Diamond. . . . . . . . . . . .
8th Continent . . . . . . . . . . . .
EdenSoy. . . . . . . . . . . . . . . .
Pacific. . . . . . . . . . . . . . . . . .
Silk . . . . . . . . . . . . . . . . . . . .
10
11
12
13
14
Soy Dream . . . . . . . . . . . . . . WestSoy . . . . . . . . . . . . . . . . Store’s Own Brand . . . . . . . . OTHER (Write In)
15
16
17
999
OTHER (Write In)
REGULAR TEA
Your Household:
Used in
Cups or
last 6
glasses/
months
average day
872
FORMS:
Flavored . . . . . . . . . . . . . . . .
Green . . . . . . . . . . . . . . . . . .
Herb Tea. . . . . . . . . . . . . . . .
Regular Blend. . . . . . . . . . . .
03
04
05
06
KINDS:
Family Size Tea Bags . . . . . . Regular Size Tea Bags . . . . . Loose Tea. . . . . . . . . . . . . . . 07
08
09
BRANDS:
Bigelow. . . . . . . . . . . . . . . . .
Celestial Seasonings . . . . . .
Constant Comment . . . . . . .
Good Earth. . . . . . . . . . . . . .
Lipton Cold Brew . . . . . . . . .
10
11
12
13
14
Lipton Decaffeinated. . . . . . .
Lipton Herbal . . . . . . . . . . . .
Lipton Regular Tea . . . . . . . .
Other Lipton . . . . . . . . . . . . .
Luzianne. . . . . . . . . . . . . . . .
15
16
17
18
19
Red Rose . . . . . . . . . . . . . . .
Salada . . . . . . . . . . . . . . . . .
Stash . . . . . . . . . . . . . . . . . .
Tazo . . . . . . . . . . . . . . . . . . .
Tetley . . . . . . . . . . . . . . . . . .
20
21
22
23
24
Traditional Medicinals . . . . . .
Twinings . . . . . . . . . . . . . . . .
Yogi Tea . . . . . . . . . . . . . . . .
25
26
27
28
999
OTHER (Write In)
READY TO DRINK
ICED COFFEE/
COFFEE DRINKS
Your Household:
Used in
Cups or
last 6
glasses/
months
last 7 days
878
00
01
02
03
04
05
Other Starbucks . . . . . . . . . . 06
999
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Illy Issimo . . . . . . . . . . . . . . .
International Delight . . . . . . .
Skinny Cow . . . . . . . . . . . . .
Starbucks DoubleShot . . . . .
Starbucks Frappuccino. . . . .
OTHER (Write In)
Your Household:
Used in
Cups or
last 6
glasses/
months
average day
873
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Sweetened - Sugar. . . . . . . .
Sweetened - Sugar Free. . . .
Unsweetened . . . . . . . . . . . .
KINDS:
With Lemon . . . . . . . . . . . . .
Without Lemon . . . . . . . . . . .
BRANDS:
4C. . . . . . . . . . . . . . . . . . . . .
Arizona . . . . . . . . . . . . . . . . .
Crystal Light Iced Tea. . . . . .
Diet Snapple. . . . . . . . . . . . .
Lipton Decaf Iced Tea Mix . .
COCOA POWDER
(for baking)
GROUND COFFEE
871
................. TOTAL:
Your Household:
Used in
Glasses or
last 12
cups/average
months day (in season)
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Flavored . . . . . . . . . . . . . . . .
Unflavored . . . . . . . . . . . . . .
FORMS:
Loose Grinds . . . . . . . . . . . .
Single Serve Pod/K-Cup . . .
BRANDS:
Barista Prima Coffeehouse. .
Café Bustelo . . . . . . . . . . . . .
Chock Full O’Nuts (Regular)
Dunkin’ Donuts Ground . . . .
Eight O’Clock . . . . . . . . . . . .
00
01
02
03
04
05
06
07
08
09
Folgers Breakfast Blend . . . .
Folgers Classic Roast. . . . . .
Folgers Classic Roast
(Decaf) . . . . . . . . . . . . . . .
Folgers 100% Colombian . . .
Folgers French Roast . . . . . .
10
11
12
13
14
Folgers Gourmet Selections . .
Folgers Special Roast . . . . .
Other Folgers . . . . . . . . . . . .
Gevalia . . . . . . . . . . . . . . . . .
Green Mountain . . . . . . . . . .
15
16
17
18
19
Hills Bros. . . . . . . . . . . . . . .
Maxwell House 100%
Colombian. . . . . . . . . . . . .
Maxwell House (Decaf) . . . .
Maxwell House Master
Blend (Regular). . . . . . . . .
Maxwell House French
Roast (Regular) . . . . . . . .
20
21
22
23
24
Maxwell House Original
(Regular). . . . . . . . . . . . . .
Other Maxwell House. . . . . .
McDonald’s McCafé . . . . . . .
Melitta. . . . . . . . . . . . . . . . . .
Millstone . . . . . . . . . . . . . . . .
25
26
27
28
29
Peet’s . . . . . . . . . . . . . . . . . .
Seattle’s Best . . . . . . . . . . . .
Starbucks . . . . . . . . . . . . . . .
Yuban (Regular) . . . . . . . . . .
Gourmet/Coffee Bar Brand .
30
31
32
33
34
Store’s Own Brand (Regular) . Store’s Own Brand (Decaf) . . . 35
36
999
OTHER (Write In)
WHOLE
COFFEE BEANS
Your Household:
Used in
Number of
last 6
pounds/
months
last 30 days
874
................. 00
TYPES:
Decaffeinated . . . . . . . . . . . . Caffeinated . . . . . . . . . . . . . . 01
02
KINDS:
Flavored . . . . . . . . . . . . . . . . Unflavored . . . . . . . . . . . . . . 03
04
BRANDS:
Dunkin’ Donuts . . . . . . . . . . .
Eight O’Clock . . . . . . . . . . . .
Gevalia . . . . . . . . . . . . . . . . .
Green Mountain . . . . . . . . . .
Millstone . . . . . . . . . . . . . . .
05
06
07
08
09
Starbucks . . . . . . . . . . . . . . . Store’s Own Brand . . . . . . . . 10
11
999
TOTAL:
OTHER (Write In)
Where purchased:
Supermarket/Grocery Store . .
Gourmet/Specialty Shop . . . .
Wholesaler/Club . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . .
875-0
1
2
3
4
FOOD/GROCERY SHOPPING
Page 107
INSTANT OR
FREEZE-DRIED
COFFEE
Your Household:
Used in
Cups or
last 6
glasses/
months
average day
00
02
Maxwell House (Decaf) . . . .
Nescafé Classic . . . . . . . . . .
Nescafé Clásico . . . . . . . . . .
Nescafé Taster’s Choice
(Regular). . . . . . . . . . . . . .
Nescafé Taster’s Choice
(Decaf) . . . . . . . . . . . . . . .
01
03
04
05
06
07
08
09
10
11
12
Starbucks VIA. . . . . . . . . . . . Store’s Own Brand . . . . . . . . 13
14
999
OTHER (Write In)
Your Household:
Used in
Cups or
last 6
glasses/
months
last 7 days
877
TOTAL: . . . . . . . . . . . . . . . . . TYPES:
Decaffeinated . . . . . . . . . . . . Regular. . . . . . . . . . . . . . . . . Sugar Free . . . . . . . . . . . . . . Fat Free . . . . . . . . . . . . . . . . BRANDS:
Folgers Cappuccino . . . . . . . Hills Bros. Cappuccino . . . . . Maxwell House International Café:
Café Vienna . . . . . . . . . . . French Vanilla . . . . . . . . . . Hazelnut . . . . . . . . . . . . . . Suisse Mocha . . . . . . . . . . Other. . . . . . . . . . . . . . . . . 00
07
08
09
10
11
12
13
14
999
Your Household:
Used in last
6 months
TOTAL: . . . . . . . . . . . . . . . . . . . .
990-0
1
ORGANIC FOODS:
Baby Food . . . . . . . . . . . . . . . .
Bread . . . . . . . . . . . . . . . . . . . .
Breakfast Cereals . . . . . . . . . . .
Cheese. . . . . . . . . . . . . . . . . . .
Chocolate . . . . . . . . . . . . . . . . .
Coffee . . . . . . . . . . . . . . . . . . . .
Fish/Seafood . . . . . . . . . . . . . . .
Frozen Foods . . . . . . . . . . . . . .
Granola . . . . . . . . . . . . . . . . . .
Ice Cream. . . . . . . . . . . . . . . . .
Juice . . . . . . . . . . . . . . . . . . . . .
2
3
4
5
6
7
8
9
0
X
Y
OTHER (Write In)
00
01
02
03
04
05
Chili . . . . . . . . . . . . . . . . . . .
Cookies . . . . . . . . . . . . . . . .
Dips . . . . . . . . . . . . . . . . . . .
Frosting . . . . . . . . . . . . . . . .
Gravies . . . . . . . . . . . . . . . . .
06
07
08
09
10
Ice Cream. . . . . . . . . . . . . . .
Jambalaya . . . . . . . . . . . . . .
Jams. . . . . . . . . . . . . . . . . . .
Jellies . . . . . . . . . . . . . . . . . .
Macaroni Salad . . . . . . . . . .
11
12
13
14
15
Pancakes . . . . . . . . . . . . . . .
Pasta . . . . . . . . . . . . . . . . . .
Pies . . . . . . . . . . . . . . . . . . .
Pizza . . . . . . . . . . . . . . . . . .
Potato Salad . . . . . . . . . . . . .
16
17
18
19
20
Salad Dressing . . . . . . . . . . .
Soup. . . . . . . . . . . . . . . . . . .
Spaghetti Sauce . . . . . . . . . .
Stew . . . . . . . . . . . . . . . . . . .
Tomato Sauce. . . . . . . . . . . .
21
22
23
24
25
Other Sauces . . . . . . . . . . . . Casseroles . . . . . . . . . . . . . . Waffles . . . . . . . . . . . . . . . . . 26
27
28
999
MICROWAVE USAGE
991-0
1
2
3
4
5
6
7
8
How often do you go
grocery shopping
in an average week?
Number of trips ______________ 881-0
TOTAL: . . . . . . . . . . . . . . . . .
FOODS:
Baby Food . . . . . . . . . . . . . .
Biscuits. . . . . . . . . . . . . . . . .
Bread . . . . . . . . . . . . . . . . . .
Cake . . . . . . . . . . . . . . . . . . .
Candy . . . . . . . . . . . . . . . . . .
In the past week, what day(s) did you shop for
groceries?
882-0
Sunday . . . . . . . . . . . . . . . .
Monday. . . . . . . . . . . . . . . .
Tuesday . . . . . . . . . . . . . . .
Wednesday. . . . . . . . . . . . .
Thursday. . . . . . . . . . . . . . .
1
2
3
4
5
Friday . . . . . . . . . . . . . . . . . 6
Saturday . . . . . . . . . . . . . . . 7
Distance from your home to the store where
you most frequently shop for groceries:
Less than 1 mile . . . . . . . . . 8
1–2 miles . . . . . . . . . . . . . . 9
3–5 miles . . . . . . . . . . . . . . 0
6–10 miles . . . . . . . . . . . . . X
11+ miles . . . . . . . . . . . . . . Y
Time of day you usually shop for groceries
883-0
(Check one):
Morning . . . . . . . . . . . . . . . 1
Afternoon . . . . . . . . . . . . . . 2
Evening . . . . . . . . . . . . . . . 3
Various Times. . . . . . . . . . . 4
Do you prepare a written grocery shopping
list in advance?
884-0
Always . . . . . . . . . . . . . . . . 1
Sometimes . . . . . . . . . . . . . 2
Never . . . . . . . . . . . . . . . . . 3
In the past 30 days, have you purchased 989-0
groceries over the Internet/online?
Yes 1
Your Household:
Used in
Times/
last 6
last 7
months
days
880
05
06
OTHER (Write In)
Meat . . . . . . . . . . . . . . . . . . . . .
Pasta . . . . . . . . . . . . . . . . . . . .
Peanut Butter . . . . . . . . . . . . . .
Poultry . . . . . . . . . . . . . . . . . . .
Soup. . . . . . . . . . . . . . . . . . . . .
Spaghetti/Pasta Sauce . . . . . . .
Tea . . . . . . . . . . . . . . . . . . . . . .
_________________________
GROCERY
SHOPPING
OTHER (Write In)
01
02
03
04
Nescafé Memento . . . . . . . . Nescafé Taster’s Choice . . . . Starbucks VIA. . . . . . . . . . . . ORGANIC FOODS
Your Household:
Made in
Times/
last 6
last 30
months
days
879
876
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Freeze-Dried . . . . . . . . . . . .
Instant Powdered/Buds . . . .
BRANDS:
Folgers Crystals (Regular) . .
Folgers Crystals (Decaf). . . .
Folgers Singles. . . . . . . . . . .
Maxwell House Coffee
Singles . . . . . . . . . . . . . . .
Maxwell House (Regular) . . .
FLAVORED INSTANT
COFFEE
FOOD PREPARED
FROM SCRATCH
In the past 30 days, did you use a
grocery store loyalty card?
TOTAL: . . . . . . . . . . . . . . . . .
For Which Meal(s):
Breakfast . . . . . . . . . . . . . . .
Lunch . . . . . . . . . . . . . . . . . .
Dinner. . . . . . . . . . . . . . . . . .
Snack . . . . . . . . . . . . . . . . .
REASON:
Cook . . . . . . . . . . . . . . . . . . .
Defrost/Thaw . . . . . . . . . . . .
Reheat leftovers . . . . . . . . . .
TYPES OF FOOD:
Baking Mixes . . . . . . . . . . . .
Food prepared from scratch
Fresh vegetables . . . . . . . . .
Frozen breakfast foods . . . . .
Frozen desserts . . . . . . . . . .
00
01
02
03
04
05
06
07
08
09
10
11
12
Frozen dinner/entrees . . . . .
Frozen side dishes . . . . . . . .
Refrigerated meals/sides . . .
Pasta . . . . . . . . . . . . . . . . . .
Popcorn . . . . . . . . . . . . . . . .
Shelf Stable (NonRefrigerated). . . . . . . . . . .
13
14
15
16
17
18
Soup. . . . . . . . . . . . . . . . . . . Take-out food . . . . . . . . . . . . 19
20
999
OTHER (Write In)
PRODUCT SAMPLES
987-0
In the last 6 months, have you used a product
sample?
Yes . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
If yes, how did you obtain the product
sample(s) you used?
Delivered in the mail. . . . . . . . . . . . . .
2
Included with the newspaper . . . . . . .
3
Obtained in-store . . . . . . . . . . . . . . . .
4
Other . . . . . . . . . . . . . . . . . . . . . . . . .
5
In the last 6 months, have you purchased a
product after using its sample?
Yes . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
CENTS OFF
COUPONS
997-0
Yes 1
Your Household:
Used in
Times
last 12
used/last
months
3 months
885
TOTAL: . . . . . . . . . . . . . . . . .
Where redeemed:
Discount Store . . . . . . . . . . .
Drug Store . . . . . . . . . . . . . .
Grocery Store/Supermarket . .
Other . . . . . . . . . . . . . . . . . .
Received or clipped from, last 12 months:
Handed out by person in store . . . . . .
In or on packages. . . . . . . . . . . . . . . .
Magazine . . . . . . . . . . . . . . . . . . . . . .
Mail. . . . . . . . . . . . . . . . . . . . . . . . . . .
Sunday newspaper/inserts . . . . . . . .
00
01
02
03
999
886-0
1
2
3
4
5
Weekday newspaper/inserts . . . . . . . .
In-store circulars. . . . . . . . . . . . . . . . . . .
Instant coupon machine/Shelf coupons
Preferred customer/loyalty card . . . . .
Coupons at register . . . . . . . . . . . . . .
6
7
8
9
0
Internet or E-mail on cell phone . . . . .
Other Internet or E-mail . . . . . . . . . . .
X
Y
Use coupons to:
Save as much money as I can . . . . . .
Save on brands I use now . . . . . . . . .
Try new products . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . .
1
2
3
4
Types of products used for:
Beverages . . . . . . . . . . . . . . . . . . . . .
Cleaning products . . . . . . . . . . . . . . .
Cosmetics. . . . . . . . . . . . . . . . . . . . . .
Food products . . . . . . . . . . . . . . . . . .
Tobacco . . . . . . . . . . . . . . . . . . . . . . .
5
6
7
8
9
Toiletry items . . . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . .
0
X
Total number of coupons used, last
30 days:
(Write in number)
887-0
994-0
HOUSEHOLD PRODUCTS
TOILET PAPER
Your Household:
Used in
Rolls/
last 6
last 30
months
days
Page 108
PAPER TOWELS
888
00
TYPES:
Plain White . . . . . . . . . . . . . . Print . . . . . . . . . . . . . . . . . . . 02
01
FORMS:
Moist. . . . . . . . . . . . . . . . . . . Dry . . . . . . . . . . . . . . . . . . . . BRANDS:
Angel Soft . . . . . . . . . . . . . . .
Charmin Basic . . . . . . . . . . .
Charmin Freshmates
(Moist Wipes) . . . . . . . . . . .
Charmin Sensitive . . . . . . . .
Charmin Ultra Soft . . . . . . . .
Charmin Ultra Strong . . . . . .
Cottonelle Clean Care . . . . .
Cottonelle Fresh Care
(Moist Wipes) . . . . . . . . . .
Cottonelle Gentle Care . . . . .
Cottonelle Ultra. . . . . . . . . . .
05
06
07
08
09
10
11
Scott Naturals. . . . . . . . . . . .
Soft ’n Gentle . . . . . . . . . . . .
White Cloud . . . . . . . . . . . . .
FACIAL TISSUES
04
OTHER (Write In)
03
Marcal Small Steps . . . . . .
Quilted Northern Soft &
Strong . . . . . . . . . . . . . . . .
Quilted Northern Ultra Plush. .
Scott 1000 . . . . . . . . . . . . . .
Scott Extra Soft. . . . . . . . . . .
12
13
14
15
16
17
20
TYPES:
Scented . . . . . . . . . . . . . . . . Unscented . . . . . . . . . . . . . . FORMS:
Box . . . . . . . . . . . . . . . . . . . . Soft Pack . . . . . . . . . . . . . . . BRANDS:
Kleenex Anti-Viral . . . . . . . . .
Kleenex Expressions . . . . . .
Kleenex Lotion . . . . . . . . . . .
Kleenex Regular. . . . . . . . . .
Kleenex Ultra Soft. . . . . . . . .
Other Kleenex . . . . . . . . . . .
Marcal Small Steps . . . . . . .
Puffs Basic . . . . . . . . . . . . . .
Puffs Plus Lotion. . . . . . . . . .
Puffs Ultra Soft & Strong. . . .
Scotties. . . . . . . . . . . . . . . . . Store’s Own Brand . . . . . . . . OTHER (Write In)
00
02
Bounty Select-a-Size . . . . . .
Brawny . . . . . . . . . . . . . . . . .
Brawny Big Roll . . . . . . . . . .
Fiora . . . . . . . . . . . . . . . . . . .
Kleenex Hand Towels . . . . . .
Mardi Gras . . . . . . . . . . . . . .
Scott . . . . . . . . . . . . . . . . . . .
Scott Mega Roll . . . . . . . . . .
Scott Naturals. . . . . . . . . . . .
01
03
04
05
06
07
08
09
10
12
13
22
15
16
17
18
19
20
999
TOTAL:
01
02
03
04
Mardi Gras . . . . . . . . . . . . . .
Soft & Silky . . . . . . . . . . . . . .
Vanity Fair. . . . . . . . . . . . . . .
Viva. . . . . . . . . . . . . . . . . . . .
05
06
OTHER (Write In)
09
01
12
13
14
15
16
999
00
01
02
03
04
05
06
07
08
09
999
Your Household:
Used in
Packs/
last 6
last 30
months
days
893
TOTAL:
................. BRANDS:
Clorox Dust Wipes . . . . . . . .
Easy Wipe Cloths . . . . . . . . .
Endust Duster. . . . . . . . . . . .
Handi-Wipes. . . . . . . . . . . . .
Mr. Clean Wiping Cloth. . . . .
DISPOSABLE CUPS
00
01
02
03
04
05
06
07
08
09
999
Your Household:
Used in
Number
last 6
used/last
months
30 days
894
03
04
05
06
07
08
09
10
11
12
999
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Foam . . . . . . . . . . . . . . . . . .
Paper . . . . . . . . . . . . . . . . . .
Plastic. . . . . . . . . . . . . . . . . .
BRANDS:
Chinet. . . . . . . . . . . . . . . . . .
Dixie . . . . . . . . . . . . . . . . . . .
Hefty . . . . . . . . . . . . . . . . . . .
Solo . . . . . . . . . . . . . . . . . . .
00
02
Store’s Own Brand . . . . . . . . 01
03
04
05
06
07
08
09
999
OTHER (Write In)
RECYCLING
998-0
10
11
DRY DISPOSABLE
WIPES & DUSTERS
02
07
08
OTHER (Write In)
00
TYPES:
Dinner. . . . . . . . . . . . . . . . . . Family . . . . . . . . . . . . . . . . . . 00
OTHER (Write In)
................. BRANDS:
Bounty . . . . . . . . . . . . . . . . .
Chinet. . . . . . . . . . . . . . . . . .
Dixie . . . . . . . . . . . . . . . . . . .
Kleenex . . . . . . . . . . . . . . . .
Pledge Wipes . . . . . . . . . . . .
Scrubbing Bubbles Wipes . .
Swiffer Sweeper Wet Cloths .
Windex Wipes. . . . . . . . . . . .
Swiffer Sweeper Dry Cloths .
Swiffer Dusters . . . . . . . . . . .
Swiffer 360° Dusters . . . . . . .
Scotch Brite Cloths. . . . . . . .
Your Household:
Used in
Packs/
last 6
last 30
months
days
891
23
999
14
OTHER (Write In)
PAPER NAPKINS
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Clorox Disinfecting Wipes. . .
Glass Plus Wipes . . . . . . . . .
Green Works . . . . . . . . . . . .
Lysol Disinfecting Wipes. . . .
Murphy Soft Wipes . . . . . . . .
11
Sparkle . . . . . . . . . . . . . . . . . Viva. . . . . . . . . . . . . . . . . . . . Store’s Own Brand . . . . . . . . 21
Your Household:
Used in
Boxes/
last 6
last 30
months
days
................. 19
Your Household:
Used in
Packages/
last 6
last 30
months
days
892
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Plain White . . . . . . . . . . . . . .
Print . . . . . . . . . . . . . . . . . . .
BRANDS:
Bounty . . . . . . . . . . . . . . . . .
Bounty Basic . . . . . . . . . . . .
Bounty DuraTowel . . . . . . . .
Bounty ExtraSoft . . . . . . . . .
Bounty Prints . . . . . . . . . . . .
18
889
TOTAL:
PRE-MOISTENED
HOUSEHOLD WIPES
890
................. TOTAL:
Your Household:
Used in
Rolls/
last 6
last 30
months
days
DISPOSABLE PLATES
In the last 30 days, did you or anyone in your
household recycle or re-use any of the
following?
Batteries . . . . . . . . . . . . . . . . . . . . . . .
Electronic Equipment . . . . . . . . . . . . .
Aluminum Beverage Cans . . . . . . . . .
Other Metal items . . . . . . . . . . . . . . . .
Glass Bottles . . . . . . . . . . . . . . . . . . .
1
2
3
4
5
Other Glass items. . . . . . . . . . . . . . . .
Plastic Bottles. . . . . . . . . . . . . . . . . . .
Plastic Bags . . . . . . . . . . . . . . . . . . . .
Other Plastic Items . . . . . . . . . . . . . . .
Newspapers . . . . . . . . . . . . . . . . . . . .
Other Paper . . . . . . . . . . . . . . . . . . . .
______________________________
6
7
8
9
0
X
Y
OTHER (Write In)
Your Household:
Used in
Packages/
last 12
last 30
months
days
895
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Foam . . . . . . . . . . . . . . . . . .
Plain Paper. . . . . . . . . . . . . .
Coated Paper . . . . . . . . . . . .
Plastic. . . . . . . . . . . . . . . . . .
BRANDS:
Chinet. . . . . . . . . . . . . . . . . .
Dixie . . . . . . . . . . . . . . . . . . .
Hefty . . . . . . . . . . . . . . . . . . .
Solo . . . . . . . . . . . . . . . . . . .
Vanity Fair. . . . . . . . . . . . . . .
Generic (No Label). . . . . . . . Store’s Own Brand . . . . . . . . OTHER (Write In)
00
01
02
03
04
05
06
07
08
09
10
11
999
HOUSEHOLD PRODUCTS
Page 109
PLASTIC GARBAGE
BAGS & TRASH
last 6
CAN LINERS
Your Household:
Used in
Bags/
last 6
last 30
months
days
PLASTIC-TYPE
KITCHEN WRAP
896
TOTAL:
TYPES:
Indoor Small Trash Bags
(White) . . . . . . . . . . . . . . . Indoor Tall Kitchen Bags
(White) . . . . . . . . . . . . . . . Outdoor Trash Bags (Dark). . KINDS:
Drawstring/Cinch . . . . . . . . .
2 Flaps or Handle Tie . . . . . .
4 Flaps (Quick-Tie). . . . . . . .
Twist-Tie . . . . . . . . . . . . . . . .
BRANDS:
Brawny Essentials . . . . . . . .
Glad Kitchen. . . . . . . . . . . . .
Glad Kitchen ForceFlex . . . .
Glad Kitchen w/Febreze . . .
TOTAL:
01
TYPES:
Small (about 50 ft.) . . . . . . . .
Medium (about 100 ft.) . . . . .
Large (about 200 ft.). . . . . . .
X-Large (about 300 ft.) . . . . .
02
03
04
05
06
07
08
10
11
12
13
Hefty Black/Out . . . . . . . . . .
Hefty CinchSak. . . . . . . . . . .
Hefty EasyFlaps . . . . . . . . . .
Hefty SteelSak . . . . . . . . . . .
Hefty Ultimate. . . . . . . . . . . .
Hefty Ultra Flex. . . . . . . . . . .
Other Hefty . . . . . . . . . . . . . .
Ruffies . . . . . . . . . . . . . . . . .
Sure-Tuff. . . . . . . . . . . . . . . .
OTHER (Write In)
ALUMINUM
FOIL
14
15
16
17
18
19
20
21
22
25
00
01
02
BRANDS:
Diamond Foil . . . . . . . . . . . .
Reynolds Wrap . . . . . . . . . . .
Reynolds Wrap Non-Stick. . .
Reynolds Wrappers . . . . . . .
OTHER (Write In)
WAXED PAPER
00
02
BRANDS:
Baggies . . . . . . . . . . . . . . . .
Glad . . . . . . . . . . . . . . . . . . .
Hefty OneZip . . . . . . . . . . . .
Sure-Tuff. . . . . . . . . . . . . . . .
Ziploc Sandwich Bags . . . . .
Ziploc Freezer. . . . . . . . . . . .
Ziploc Storage . . . . . . . . . . .
Ziploc Slider Bags . . . . . . . .
Ziploc Zip’n Steam . . . . . . . .
Other Ziploc . . . . . . . . . . . . .
PLASTIC/GLASS
FOOD STORAGE
CONTAINERS
03
04
05
06
07
999
03
04
05
06
07
08
09
10
11
12
13
14
999
01
02
03
999
00
01
02
03
04
05
Rubbermaid Plastic . . . . . . .
Snapware . . . . . . . . . . . . . . .
Tupperware. . . . . . . . . . . . . .
Ziploc Twist ’n Loc . . . . . . . .
Other Ziploc Containers . . . .
06
07
08
09
10
Store’s Own Brand . . . . . . . . 11
999
OTHER (Write In)
OVEN CLEANERS
18
20
16
19
00
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Glad OvenWare . . . . . . . . . .
GladWare . . . . . . . . . . . . . .
Hefty Clip Fresh . . . . . . . . . .
Pyrex . . . . . . . . . . . . . . . . . .
Rubbermaid Glass . . . . . . .
15
17
Your Household:
Used in
Number
last 6
used/last
months
30 days
985
Your Household:
Used in
Containers/
last 6
last 6
months
months
902
TOTAL: . . . . . . . . . . . . . . . . . BRANDS:
Easy-Off Fume Free . . . . . . . Easy-Off Heavy Duty
Aerosol . . . . . . . . . . . . . . . OTHER (Write In)
TOTAL:
................. BRANDS:
Clorox . . . . . . . . . . . . . . . . . .
Clorox ToiletWand. . . . . . . . .
Green Works . . . . . . . . . . . .
Kaboom . . . . . . . . . . . . . . . .
Lime-A-Way . . . . . . . . . . . . .
Lysol Cling . . . . . . . . . . . . . .
Lysol No Mess Automatic . . .
Lysol Power & Free. . . . . . . .
Other Lysol . . . . . . . . . . . . . .
Pine-Sol . . . . . . . . . . . . . . . .
Scotch-Brite Disposable
Toilet Scrubbers . . . . . . . .
Scrubbing Bubbles Fresh
Brush . . . . . . . . . . . . . . . .
Scrubbing Bubbles Toilet
Cleaning Gel. . . . . . . . . . .
Sno Bol Liquid . . . . . . . . . . .
Soft Scrub 4-in-1 . . . . . . . . .
Ty-D-Bol . . . . . . . . . . . . . . . .
The Works . . . . . . . . . . . . . .
OTHER (Write In)
Your Household:
Used in
Times/
last 6
last 30
months
days
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Reynolds Cut-Rite . . . . . . . .
Wax-tex. . . . . . . . . . . . . . . . .
10
999
TYPES:
Heavy Duty. . . . . . . . . . . . . . Regular Weight. . . . . . . . . . . 999
01
KINDS:
Interlocking Seal. . . . . . . . . .
Open Mouth/Fold Top . . . . .
Plastic Zipper/Slider. . . . . . .
Twist-Tie . . . . . . . . . . . . . . . .
05
06
07
08
09
................. TOTAL:
24
01
02
03
04
23
Your Household:
Used in
Bags/
last 6
last 7
months
days
TYPES:
Food Storage Bags . . . . . . .
Freezer Bags
(Double Layer) . . . . . . . . .
Freezer Bags
(Single Layer) . . . . . . . . . .
Sandwich Bags. . . . . . . . . . .
Snack Bags . . . . . . . . . . . . .
Your Household:
Used in
Times/
last 6
last 7
months
days
898
................. 00
900
897
OTHER (Write In)
OTHER (Write In)
09
BRANDS:
CoverMate . . . . . . . . . . . . . .
Glad Cling Wrap . . . . . . . . . .
Glad Press’n Seal . . . . . . . . .
Saran Premium. . . . . . . . . . .
Saran Cling Plus. . . . . . . . . .
Your Household:
Used in
Containers/
last 6
last 3
months
months
903
................. 00
Glad Black (large). . . . . . . . .
Glad Black (large)
ForceFlex . . . . . . . . . . . . .
Glad Black (large)
w/Febreze . . . . . . . . . . . . .
Other Glad Trash Bags . . . . .
TOTAL:
IN-BOWL TOILET
BOWL CLEANERS
899
................. PLASTIC SANDWICH/
FOOD STORAGE/
FREEZER BAGS
Your Household:
Used in
Times/
last 6
last 7
months
days
00
01
02
999
IN-TANK TOILET
BOWL CLEANERS
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
999
Your Household:
Used in
Containers/
last 6
last 3
months
months
904
................. 00
TYPES:
Liquid . . . . . . . . . . . . . . . . . . Solid . . . . . . . . . . . . . . . . . . . 02
TOTAL:
BRANDS:
Clorox Automatic Tablet . . . .
Kaboom Scrub Free! . . . . . .
Scrubbing Bubbles Vanish
Drop-ins . . . . . . . . . . . . . .
2000 Flushes - Bleach . . . . .
2000 Flushes - Blue Plus
Bleach. . . . . . . . . . . . . . . .
2000 Flushes - Blue Plus
Detergents . . . . . . . . . . . .
Ty-D-Bol . . . . . . . . . . . . . . . .
The Works . . . . . . . . . . . . . .
OTHER (Write In)
DRAIN/SEPTIC
TANK CLEANERS
01
03
04
05
06
07
08
09
10
11
999
Your Household:
Used in
Containers/
last 6
last 6
months
months
905
TOTAL:
................. BRANDS:
Doctor Drain Septic
Treatment . . . . . . . . . . . . .
Drano Dual Force Foam . . . .
Drano Liquid Regular . . . . . .
Drano Max Gel . . . . . . . . . . .
Drano Septic Treatment . . . .
00
01
02
03
04
05
06
07
08
09
10
Liquid-Plumr Urgent Clear . . Other Liquid-Plumr . . . . . . . . Rid-X Septic Cleaner . . . . . . 11
12
13
999
Other Drano . . . . . . . . . . . . .
Liquid-Plumr Double Impact .
Liquid-Plumr Full Clog
Destroyer . . . . . . . . . . . . .
Liquid-Plumr (Regular) . . . . .
Liquid-Plumr Foaming
Clog Fighter . . . . . . . . . . .
OTHER (Write In)
HOUSEHOLD PRODUCTS
DISHWASHING
LIQUID
Your Household:
Used in
Sinksful of
last 6
dishes/last
months
7 days
906
TOTAL:
BRANDS:
Ajax Lemon . . . . . . . . . . . . .
Other Ajax . . . . . . . . . . . . . .
Dawn Hand Renewal with
Olay Beauty . . . . . . . . . . .
Dawn Plat. Bleach Alt . . . . . .
Dawn Plat. Erasing Foam . . .
Dawn Plat. Power Clean . . . .
Dawn Ultra Antibacterial . . . .
Dawn Ultra Original . . . . . . .
Other Dawn . . . . . . . . . . . . .
Gain . . . . . . . . . . . . . . . . . . .
01
02
03
04
05
Palmolive Original . . . . . . . .
Palmolive Oxy . . . . . . . . . . .
Palmolive pure + clear . . . . .
Palmolive Soft Touch w/Aloe
Other Palmolive . . . . . . . . . .
Seventh Generation . . . . . . .
Sun. . . . . . . . . . . . . . . . . . . .
Sunlight . . . . . . . . . . . . . . . .
OTHER (Write In)
00
Green Works . . . . . . . . . . . .
Ivory . . . . . . . . . . . . . . . . . . .
Joy . . . . . . . . . . . . . . . . . . . .
Mrs. Meyer’s Clean Day . . . .
Palmolive Antibacterial . . . . .
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
999
Your Household:
Used in
Loads of
last 6
dishes/last
months
7 days
907
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Gel/Liquid Detergent . . . . . .
Gel Pacs. . . . . . . . . . . . . . . .
Powder Detergent. . . . . . . . .
Rinsing Agents . . . . . . . . . . .
Tablet Detergents . . . . . . . . .
BRANDS:
Cascade ActionPacs. . . . . . .
Cascade Complete. . . . . . . .
Cascade Platinum . . . . . . . .
Cascade Rinse Aid . . . . . . . .
Finish . . . . . . . . . . . . . . . . . .
Finish All-in-1 Gel Pacs . . . .
Finish All-in-1 PowerBall . . .
Finish Jet-Dry . . . . . . . . . . . .
Finish Quantum . . . . . . . . . .
Oxi Clean . . . . . . . . . . . . . . .
00
01
02
03
04
05
Palmolive eco+ . . . . . . . . . . . Sunlight . . . . . . . . . . . . . . . . Store’s Own Brand . . . . . . . . 06
07
08
09
10
11
12
13
14
15
16
17
18
999
OTHER (Write In)
HEAVY DUTY
HAND CLEANERS
Your Household:
Used in
Times/
last 6
last 30
months
days
913
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Gojo . . . . . . . . . . . . . . . . . . .
Goop . . . . . . . . . . . . . . . . . .
Lava . . . . . . . . . . . . . . . . . . .
Simple Green Heavy
Duty Gel . . . . . . . . . . . . . .
OTHER (Write In)
HOUSEHOLD
CLEANERS
Your Household:
Used in
Containers/
last 6
last 3
months
months
SCOURING PADS
909
................. AUTOMATIC
DISHWASHER
DETERGENT
Page 110
00
01
02
03
CLR . . . . . . . . . . . . . . . . . . .
Comet Bathroom Spray . . . .
Fabuloso. . . . . . . . . . . . . . . .
Formula 409 . . . . . . . . . . . . .
Greased Lightning . . . . . . . .
Green Works . . . . . . . . . . . .
Kaboom . . . . . . . . . . . . . . . .
LA’s Totally Awesome . . . . . .
Lestoil . . . . . . . . . . . . . . . . . .
Lime-a-way. . . . . . . . . . . . . .
Lysol All Purpose . . . . . . . . .
Lysol Kitchen Cleaner . . . . .
Lysol Bathroom Cleaner . . . .
Lysol Brand Disinfectant. . . .
Lysol Mold & Mildew
Remover . . . . . . . . . . . . . .
Lysol Multi-Purpose Cleaner
Lysol Multi-Surface Liquid . .
Mean Green . . . . . . . . . . . . .
Method All Purpose . . . . . . .
Mr. Clean Antibacterial
Multi-Surfaces Spray. . . . .
OxiClean . . . . . . . . . . . . . . .
Parsons Ammonia . . . . . . . .
Pine-Sol . . . . . . . . . . . . . . . .
Pine-Sol Lavender . . . . . . . .
Pine-Sol Lemon . . . . . . . . . .
Pledge Multi Surface . . . . . . Scrub Free . . . . . . . . . . . . . . Scrubbing Bubbles Automatic
Shower Cleaner . . . . . . . . Scrubbing Bubbles Bathroom
Cleaner . . . . . . . . . . . . . . . Scrubbing Bubbles Heavy
Duty w/Fantastik . . . . . . . . Simple Green . . . . . . . . . . . .
Soft Scrub Total . . . . . . . . . .
Spic & Span Liquid . . . . . . .
Spic & Span Powder . . . . . .
Tilex Bathroom Cleaner . . .
Tilex Fresh Shower . . . . . . . .
Tilex Mold & Mildew Remover
X-14 . . . . . . . . . . . . . . . . . . .
04
999
911
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Bucket Dilutable . . . . . . . . . .
Liquid . . . . . . . . . . . . . . . . . .
Powder . . . . . . . . . . . . . . . . .
Spray (pump or aerosol). . . .
KINDS:
Refill . . . . . . . . . . . . . . . . . . .
Regular. . . . . . . . . . . . . . . . .
BRANDS:
Arm & Hammer Baking
Soda . . . . . . . . . . . . . . . . .
Clean Shower. . . . . . . . . . . .
Clorox Bleach Foamer . . . . .
Clorox Clean-Up. . . . . . . . . .
Clorox Disinfecting
Bathroom Cleaner. . . . . . .
Mr. Clean Concentrated
Cleaner . . . . . . . . . . . . . . .
Mr. Clean Multi-Purpose
Liquid . . . . . . . . . . . . . . . .
Mr. Clean with Febreze. . . . .
Mrs. Meyer’s Clean Day . . . .
Murphy’s Oil Soap . . . . . . . .
OTHER (Write In)
Your Household:
Used in
Pads/
last 6
last 30
months
days
00
01
02
03
04
05
06
07
08
09
10
11
12
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Brillo . . . . . . . . . . . . . . . . . . .
Chore Boy . . . . . . . . . . . . . .
Mr. Clean Magic Eraser . . . .
O-Cel-O Scrub Sponge . . . .
Scotch-Brite Dobie . . . . . . . .
Scotch-Brite Non-Scratch. . .
Scotch-Brite Scrub Sponge .
S.O.S Regular . . . . . . . . . . .
S.O.S Clean ’n Toss . . . . . . .
S.O.S Scrubbing Sponge . . .
Store’s Own Brand . . . . . . . . RUBBER GLOVES
................. TOTAL:
16
BRANDS:
Playtex HandSaver Gloves . . Playtex Living Gloves . . . . . . 19
23
SCOURING
CLEANSERS
24
25
26
27
28
29
30
31
32
33
36
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
999
07
08
09
10
11
999
00
01
02
999
Your Household:
Used in
Containers/
last 6
last 30
months
days
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Ajax with Bleach . . . . . . . . . .
Bar Keepers Friend . . . . . . .
Bon Ami . . . . . . . . . . . . . . . .
Comet Powder . . . . . . . . . . .
Comet Soft Cleanser . . . . . .
Soft Scrub Gel . . . . . . . . . . .
Soft Scrub Lemon. . . . . . . . .
Soft Scrub with Bleach . . . . .
OTHER (Write In)
GLASS AND
SURFACE CLEANERS
37
38
06
908
34
35
05
OTHER (Write In)
21
22
04
Your Household:
Used in
Pairs/
last 6
last 6
months
months
15
20
03
912
14
18
01
02
OTHER (Write In)
13
17
00
00
01
02
03
04
05
06
07
08
09
999
Your Household:
Used in
Containers/
last 6
last 6
months
months
914
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Cinch . . . . . . . . . . . . . . . . . .
Clorox Anywhere Hard
Surface . . . . . . . . . . . . . . .
Formula 409 Glass &
Surface . . . . . . . . . . . . . . .
Glass Plus . . . . . . . . . . . . . .
Green Works . . . . . . . . . . . .
00
01
02
Invisible Glass . . . . . . . . . . .
Method Glass + Surface. . . .
Sparkle . . . . . . . . . . . . . . . . .
Regular (Blue) Windex . . . . .
Windex Multi-Surface . . . . . .
Windex Multi-Surface
(w/Vinegar) . . . . . . . . . . . .
Windex Outdoor . . . . . . . . . .
Other Windex . . . . . . . . . . . .
OTHER (Write In)
03
04
05
06
07
08
09
10
11
12
13
14
999
HOUSEHOLD PRODUCTS
Page 111
FURNITURE POLISH
Your Household:
Used in
Containers/
last 6
last 6
months
months
................. 00
TYPES:
Aerosol . . . . . . . . . . . . . . . . . Liquid . . . . . . . . . . . . . . . . . . Oil. . . . . . . . . . . . . . . . . . . . . BRANDS:
Behold . . . . . . . . . . . . . . . . .
Behold Lemon . . . . . . . . . . .
Endust . . . . . . . . . . . . . . . . .
Favor . . . . . . . . . . . . . . . . . .
Old English. . . . . . . . . . . . . .
Orange Glo. . . . . . . . . . . . . .
Pledge Lemon Clean . . . . . .
Pledge Extra Moisturizing . .
Pledge Multi Surface . . . . . .
Pledge Revitalizing Oil . . . .
Other Pledge . . . . . . . . . . . .
Scott’s Liquid Gold . . . . . . . .
Swiffer Dust & Shine. . . . . . .
OTHER (Write In)
FLOOR CLEANER,
WAX & POLISH
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
999
Your Household:
Used in
Containers/
last 6
last 6
months
months
................. TYPES:
Cleaner. . . . . . . . . . . . . . . . .
One Step Clean & Shine . . .
Polish . . . . . . . . . . . . . . . . . .
Liquid Wax . . . . . . . . . . . . . .
BRANDS:
Armstrong Floor Cleaner . . .
Bona. . . . . . . . . . . . . . . . . . .
Mop & Glo . . . . . . . . . . . . . .
Murphy Oil Soap . . . . . . . . .
Orange Glo Hardwood Floor .
Pledge Multi Surface Floor .
Pledge Wood Floor Cleaner
Swiffer Bissell Steamboost . .
Swiffer Sweeper . . . . . . . . . .
Swiffer Wet Jet . . . . . . . . . . .
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
999
OTHER (Write In)
Used for:
918-0
Conventional/Regular Floor 1
No Wax Floor . . . . . . . . . . . 2
ENVIRONMENTALLY
FRIENDLY/“GREEN”
PRODUCTS
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Liquid . . . . . . . . . . . . . . . . . .
Spray (pump or aerosol). . . .
Powder/Granules . . . . . . . . .
KINDS:
Whole Room. . . . . . . . . . . . .
Spot Cleaner . . . . . . . . . . . .
BRANDS:
Bissell. . . . . . . . . . . . . . . . . .
409 Carpet Cleaner . . . . . . .
Resolve Deep Clean . . . . . .
Resolve Easy Clean . . . . . . .
Resolve High-Traffic . . . . . . .
Resolve Pet Stain Instant
Eraser . . . . . . . . . . . . . . .
Resolve Triple Oxi Advanced
Other Resolve . . . . . . . . . . .
Spot Shot . . . . . . . . . . . . . . .
Woolite . . . . . . . . . . . . . . . . .
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
Store’s Own Brand . . . . . . . . 16
999
OTHER (Write In)
AIR FRESHENERS,
CARPET & ROOM
DEODORIZERS
Your Household:
Used in
Containers/
last 6
last 3
months
months
Your Household:
Used in last
6 months
TOTAL: . . . . . . . . . . . . . . . . . . . . . .
992-0
1
Recycled-Content Paper Products:
Facial Tissues. . . . . . . . . . . . . . . .
Paper Napkins . . . . . . . . . . . . . . .
Paper Plates. . . . . . . . . . . . . . . . .
Paper Towels . . . . . . . . . . . . . . . .
Toilet Paper. . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . .
2
3
4
5
6
7
Non-Toxic/Biodegradable Products:
All Purpose Household Cleaner . . .
Dish Washing Liquid/Detergent . . .
Glass/Surface Cleaners . . . . . . . .
Laundry Detergent . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . .
Light Bulbs . . . . . . . . . . . . . . . . . . .
993-0
1
2
3
4
5
6
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Candles . . . . . . . . . . . . . . . .
Electric . . . . . . . . . . . . . . . . .
Fan . . . . . . . . . . . . . . . . . . .
Liquid/Oil . . . . . . . . . . . . . . .
Potpourri. . . . . . . . . . . . . . . .
Powder . . . . . . . . . . . . . . . . .
Solid . . . . . . . . . . . . . . . . . . .
Spray/Aerosol . . . . . . . . . . . .
BRANDS:
Air Wick Candles . . . . . . . . .
Air Wick Freshmatic . . . . . . .
Air Wick Regular Spray. . . . .
Air Wick Scented Oil . . . . . . .
Arm & Hammer Carpet
Deodorizer . . . . . . . . . . . .
Arm & Hammer Carpet
Deodorizer Pet Fresh . . . .
Carpet Fresh . . . . . . . . . . . .
Febreze Air Effects . . . . . . . .
Febreze Candles . . . . . . . . .
Febreze Fabric Refresher. . .
Febreze Home Collection . . .
Febreze Noticeables. . . . . . .
Febreze Sleep Serenity . . . .
Febreze Stick & Refresh. . . .
19
20
21
22
23
Glade Candle . . . . . . . . . . . .
Glade Plug-Ins . . . . . . . . . . .
Glade Carpet & Room
Deodorizer . . . . . . . . . . . .
Glade Sense & Spray. . . . . .
Glade Spray . . . . . . . . . . . . .
Other Glade . . . . . . . . . . . . .
Lysol Disinfectant Spray . . . .
Lysol Neutra-Air Spray . . . . .
Renuzit Cones . . . . . . . . . . .
Other Renuzit . . . . . . . . . . . .
Yankee Candle . . . . . . . . . . .
24
25
OTHER (Write In)
00
01
02
03
04
05
06
07
08
09
10
11
12
13
SOAP &
DETERGENTS FOR
REGULAR LAUNDRY
Your Household:
Used in
Washloads/
last 6
last 7
months
days
921
920
917
TOTAL:
Your Household:
Used in
Containers/
last 6
last 6
months
months
919
916
TOTAL:
CARPET AND
RUG CLEANERS
14
15
16
17
18
26
27
28
29
30
31
32
33
34
35
999
TOTAL: . . . . . . . . . . . . . . . . .
FORMS:
Liquid . . . . . . . . . . . . . . . . . .
Powder . . . . . . . . . . . . . . . . .
Tablets . . . . . . . . . . . . . . . . .
Pacs/Pods . . . . . . . . . . . . . .
KINDS:
Ultra . . . . . . . . . . . . . . . . . . .
Regular. . . . . . . . . . . . . . . . .
TYPES:
High Efficiency (HE) . . . . . . .
Regular (Not HE) . . . . . . . . .
BRANDS:
Ajax . . . . . . . . . . . . . . . . . . .
All Free Clear . . . . . . . . . . . .
All OXI . . . . . . . . . . . . . . . . .
All Stainlifter . . . . . . . . . . . . .
Arm & Hammer Free . . . . . .
Arm & Hammer plus
OxiClean. . . . . . . . . . . . . .
Arm & Hammer (Regular). . .
Cheer . . . . . . . . . . . . . . . . . .
Dreft . . . . . . . . . . . . . . . . . . .
Dynamo . . . . . . . . . . . . . . . .
Era . . . . . . . . . . . . . . . . . . . .
Fab . . . . . . . . . . . . . . . . . . . .
Gain . . . . . . . . . . . . . . . . . . .
Gain Flings . . . . . . . . . . . . . .
Green Works . . . . . . . . . . . .
Method . . . . . . . . . . . . . . . . .
OxiClean . . . . . . . . . . . . . . .
Purex Regular. . . . . . . . . . . .
Purex with Bleach. . . . . . . . .
Seventh Generation . . . . . . .
Sun. . . . . . . . . . . . . . . . . . . .
Tide Coldwater . . . . . . . . . . .
Tide Free & Gentle . . . . . . . .
Tide HE. . . . . . . . . . . . . . . . .
Tide Liquid . . . . . . . . . . . . . .
Tide plus Downy . . . . . . . . . .
Tide plus Febreze . . . . . . . . .
Tide Pods . . . . . . . . . . . . . .
Tide (Regular). . . . . . . . . . . .
Wisk . . . . . . . . . . . . . . . . . . .
Woolite Liquid . . . . . . . . . . . . Xtra. . . . . . . . . . . . . . . . . . . . Store’s Own Brand . . . . . . . . 00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
999
OTHER (Write In)
Do You Buy Refills?
922-0
Yes . . . . . . . . . . . . . . . . . . . 1
No. . . . . . . . . . . . . . . . . . . . 2
SPRAY STARCH
Your Household:
Used in
Containers/
last 6
last 6
months
months
923
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Light . . . . . . . . . . . . . . . . . . .
Heavy . . . . . . . . . . . . . . . . . .
Regular. . . . . . . . . . . . . . . . .
BRANDS:
Easy-on . . . . . . . . . . . . . . . .
Faultless . . . . . . . . . . . . . . . .
Magic Finish/Magic Spray . .
Niagara. . . . . . . . . . . . . . . . .
OTHER (Write In)
00
01
02
03
04
05
06
07
999
HOUSEHOLD PRODUCTS/PETS
LAUNDRY PRETREATMENTS &
STAIN REMOVERS
Your Household:
Used in
Washloads/
last 6
last 7
months
days
SOAP &
DETERGENTS FOR
FINE FABRICS
929
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Gel . . . . . . . . . . . . . . . . . . . .
Liquid . . . . . . . . . . . . . . . . . .
Pacs . . . . . . . . . . . . . . . . . . .
Powder . . . . . . . . . . . . . . . . .
Spray . . . . . . . . . . . . . . . . . .
00
01
02
03
04
05
Stick . . . . . . . . . . . . . . . . . . .
Wipes . . . . . . . . . . . . . . . . . .
BRANDS:
Biz . . . . . . . . . . . . . . . . . . . .
Clorox Bleach Pen . . . . . . . .
Clorox Oxi Magic . . . . . . . . .
Clorox 2 Stain Remover &
Color Booster . . . . . . . . . .
OxiClean . . . . . . . . . . . . . . .
06
07
08
09
10
11
12
Resolve . . . . . . . . . . . . . . . .
Shout . . . . . . . . . . . . . . . . . .
Shout Color Catcher. . . . . . .
Tide Boost . . . . . . . . . . . . . .
Tide Stain Release . . . . . . . .
13
14
15
16
17
Tide to Go. . . . . . . . . . . . . . . Zout . . . . . . . . . . . . . . . . . . . 18
19
999
Your Household:
Used in
Washloads/
last 6
last 7
months
days
926
................. 00
TYPES:
Chlorine - Liquid . . . . . . . . . . Color Safe - Liquid . . . . . . . . Color Safe - Powder/Packet. . 01
02
03
BRANDS:
Borateem . . . . . . . . . . . . . . .
Clorox (Regular) . . . . . . . . . .
Clorox (Scented). . . . . . . . . .
Clorox Splash-Less . . . . . . .
Clorox Ultimate Care . . . . . .
Green Works . . . . . . . . . . . .
Purex 2 . . . . . . . . . . . . . . . . .
OTHER (Write In)
04
05
06
07
08
09
10
11
999
How used:
927-0
Household Cleaner . . . . . . . 1
Laundry . . . . . . . . . . . . . . . . 2
00
TYPES:
Liquid . . . . . . . . . . . . . . . . . . Powder . . . . . . . . . . . . . . . . . 01
02
BRANDS:
Delicare . . . . . . . . . . . . . . . .
Dreft . . . . . . . . . . . . . . . . . . .
Dryel. . . . . . . . . . . . . . . . . . .
Ivory Snow . . . . . . . . . . . . . .
Woolite Liquid . . . . . . . . . . . .
Woolite Darks . . . . . . . . . . . .
FABRIC
SOFTENERS/
SCENT BOOSTERS
932-0
Does your household own a water filter?
Yes 1
What type(s) do you use?
In-Faucet . . . . . . . . . . . . . . . . . . 2
In-line (in pipe) . . . . . . . . . . . . . . 3
End of Faucet . . . . . . . . . . . . . . . 4
Pour-Through Container/Pitcher . 5
Refrigerator Filter . . . . . . . . . . . . 6
In-bottle . . . . . . . . . . . . . . . . . . . 7
Other . . . . . . . . . . . . . . . . . . . . . 8
915-0
1
2
3
4
5
6
TOTAL: . . . . . . . . . . . . . . . . .
KINDS:
Sheets . . . . . . . . . . . . . . . . .
Liquid . . . . . . . . . . . . . . . . . .
Dryer Bar . . . . . . . . . . . . . . .
Beads . . . . . . . . . . . . . . . . . .
BRANDS:
Arm & Hammer. . . . . . . . . . .
Bounce Bursts . . . . . . . . . . .
Bounce Dryer Bars. . . . . . . .
Bounce Free. . . . . . . . . . . . .
Bounce Fresh Linen . . . . . . .
Bounce Outdoor Fresh . . . . .
Bounce w/Febreze . . . . . . . .
Other Bounce . . . . . . . . . . . .
Cuddle Soft. . . . . . . . . . . . . .
Downy April Fresh . . . . . . . .
Downy Clean Breeze . . . . . .
Downy Free & Gentle . . . . . .
Downy Fresh Protect . . . . . .
Downy Infusions . . . . . . . . . .
Downy Mountain Spring . . . .
Downy Unstopables . . . . . . .
Downy w/Febreze. . . . . . . . .
Other Downy . . . . . . . . . . . .
Final Touch . . . . . . . . . . . . . .
Gain (Fabric Softener) . . . . .
Gain Fireworks . . . . . . . . . . .
Purex . . . . . . . . . . . . . . . . . .
Snuggle Exhilarations. . . . . .
Other Snuggle . . . . . . . . . . .
Suavitel. . . . . . . . . . . . . . . . .
How used:
Baby Clothes/Diapers. . . . . .
Fine Washables . . . . . . . . . .
Other Laundry . . . . . . . . . . .
When used:
Wash Cycle (liquid). . . . . . . .
Rinse (liquid) . . . . . . . . . . . .
In the Dryer (dryer sheet) . . .
03
04
05
01
02
03
04
In the last 12 months, how many times
have you or another household member
taken a pet to the veterinarian?
Number of Times _________ 935-0
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
999
931-0
4
5
6
06
07
08
09
10
11
12
13
14
15
16
17
Does your household have pet insurance? 928-0
05
06
07
08
09
1
2
3
................. OTHER (Write In)
08
09
999
Your Household:
Used in
Times used/
last 12
last 12
months
months
TYPE OF SERVICE:
Daycare . . . . . . . . . . . . . . . .
Boarding/Kennel. . . . . . . . . .
Grooming . . . . . . . . . . . . . . .
Training . . . . . . . . . . . . . . . . .
01
02
00
03
04
05
06
07
933
TOTAL:
Number
Your Household:
Used in
Washloads/
last 6
last 7
months
days
930
PROFESSIONAL
PET SERVICES
Write in the number of
dogs, cats, birds, horses
and other pets your
household owns.
Number of Dogs . . . . . . . . . .
Dogs Under 1 Year Old. . . . .
Dogs 1 Year or Older, but
Under 2 Years Old. . . . . . .
Dogs 2-6 Years Old. . . . . . . .
Dogs 7+ Years Old . . . . . . . .
Number of Dogs by Size
Dogs 10 lbs. or less. . . . . . . .
Dogs 11-20 lbs. . . . . . . . . . . .
Dogs 21-60 lbs.. . . . . . . . . . .
Dogs 61 or more lbs. . . . . . .
Number of Cats . . . . . . . . . . .
Cats Under 1 Year Old . . . . .
Cats 1 Year or Older, but
Under 2 Years Old. . . . . . .
Cats 2-6 Years Old . . . . . . . .
Cats 7+ Years Old. . . . . . . . .
Number of Birds . . . . . . . . . .
Number of Horses . . . . . . . .
Number of Other Pets . . . . .
OTHER (Write In)
WATER FILTERS
BRANDS:
Brita . . . . . . . . . . . . . . . . . . . . . .
Filtrete . . . . . . . . . . . . . . . . . . . .
- .......................
Pur
Whirlpool . . . . . . . . . . . . . . . . . .
ZeroWater. . . . . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . .
PET OWNERSHIP/
VETERINARIAN
VISITS
934
................. TOTAL:
OTHER (Write In)
OTHER (Write In)
TOTAL:
Your Household:
Used in
Washloads/
last 6
last 7
months
days
924
BLEACH
Page 112
00
01
02
03
04
999
Yes 1
In the last 12 months,
where did your
household purchase . . .
Pet
Food
936
1
Flea Control
Products
2
Grocery/Supermarket . . . . . . .
Discount Store. . . . . . . . . . . . .
Wholesale Membership Club .
PETCO . . . . . . . . . . . . . . . . . .
PetSmart . . . . . . . . . . . . . . . . .
01
02
03
04
05
Other Pet Specialty Store . . . .
Veterinarian . . . . . . . . . . . . . . .
Internet/Online . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . .
06
07
08
09
FLEA, TICK &
PARASITE
PRODUCTS FOR
DOGS & CATS
Your Household:
Containers
Used in
or
last 12
collars/last
months
12 months
937
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Collar for Dogs . . . . . . . . . . .
Collar for Cats. . . . . . . . . . . .
Dip . . . . . . . . . . . . . . . . . . . .
Drops . . . . . . . . . . . . . . . . . .
Powder . . . . . . . . . . . . . . . . .
Repellent . . . . . . . . . . . . . . .
Shampoo . . . . . . . . . . . . . . .
Spray . . . . . . . . . . . . . . . . . .
Tablets . . . . . . . . . . . . . . . . .
BRANDS:
Adams . . . . . . . . . . . . . . . . .
Advantage . . . . . . . . . . . . . .
Advantage Multi . . . . . . . . . .
Comfortis . . . . . . . . . . . . . . .
Frontline . . . . . . . . . . . . . . . .
Hartz . . . . . . . . . . . . . . . . . .
Heartgard Plus . . . . . . . . . . .
K9 Advantix . . . . . . . . . . . . .
NexGard . . . . . . . . . . . . . . . .
PetArmor . . . . . . . . . . . . . . .
Revolution. . . . . . . . . . . . . . .
Sentinel . . . . . . . . . . . . . . . .
Sentry Fiproguard. . . . . . . . .
Sergeants . . . . . . . . . . . . . . .
Trifexis . . . . . . . . . . . . . . . . .
OTHER (Write In)
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
999
PETS & PET FOOD
Page 113
Your Household:
Used in Containers/
last 6
last 7
months
days
CANNED/WET
DOG FOOD
938
TOTAL:
Your Household:
Used in
Packages/
last 6
last 30
months
days
DOG BISCUITS
OR TREATS
941
................. TYPES:
Small Can. . . . . . . . . . . . . . .
Large Can. . . . . . . . . . . . . . .
Pouch . . . . . . . . . . . . . . . . . .
Plastic Container/Tub . . . . . .
BRANDS:
Alpo . . . . . . . . . . . . . . . . . . .
Beneful . . . . . . . . . . . . . . . . .
Blue Buffalo . . . . . . . . . . . . .
Cesar . . . . . . . . . . . . . . . . . .
Eukanuba . . . . . . . . . . . . . . .
Freshpet . . . . . . . . . . . . . . . .
Hill’s Science Diet. . . . . . . . .
Iams . . . . . . . . . . . . . . . . . . .
Kibbles ’n Bits. . . . . . . . . . . .
Moist & Meaty . . . . . . . . . . .
Nutro. . . . . . . . . . . . . . . . . . .
Ol’ Roy . . . . . . . . . . . . . . . . .
Pedigree . . . . . . . . . . . . . . . .
Pro Plan . . . . . . . . . . . . . . . .
Purina ONE . . . . . . . . . . . . .
Rachael Ray Nutrish . . . . . .
OTHER (Write In)
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
999
Your Household:
Used in
Pounds/
last 6
last 30
months
days
PACKAGED DRY
DOG FOOD
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Alpo Treats . . . . . . . . . . . . . .
Beggin’ Strips . . . . . . . . . . . .
Beneful . . . . . . . . . . . . . . . .
Blue Buffalo . . . . . . . . . . . . .
Busy . . . . . . . . . . . . . . . . . . .
Canine Carry Outs . . . . . . . .
Cesar Treats . . . . . . . . . . . . .
Dogswell. . . . . . . . . . . . . . . .
Eukanuba . . . . . . . . . . . . . . .
Greenies. . . . . . . . . . . . . . . .
Iams . . . . . . . . . . . . . . . . . . .
Meaty Bone . . . . . . . . . . . . .
Milk-Bone Dog Biscuits . . . .
Milk-Bone Treats. . . . . . . . . .
Milo’s Kitchen . . . . . . . . . . . .
Nature’s Recipe . . . . . . . . . .
Nudges. . . . . . . . . . . . . . . . .
Nutro/Nutro Max . . . . . . . . . .
Ol’ Roy . . . . . . . . . . . . . . . . .
Old Mother Hubbard. . . . . . .
Pedigree Breathbuster . . . . .
Pedigree Dentastix . . . . . . . .
Pedigree Jumbone . . . . . . . .
Pup-Peroni . . . . . . . . . . . . . .
Snausages . . . . . . . . . . . . . .
T Bonz Dog Snacks . . . . . . .
Waggin’ Train . . . . . . . . . . . .
Wellness . . . . . . . . . . . . . . . .
939
TOTAL:
OTHER (Write In)
................. SIZE OF BAG:
6 lbs. or less . . . . . . . . . . . . .
7-17 lbs. . . . . . . . . . . . . . . . .
18-30 lbs. . . . . . . . . . . . . . . .
31 lbs. or more . . . . . . . . . . .
BRANDS:
Alpo . . . . . . . . . . . . . . . . . . .
Beneful . . . . . . . . . . . . . . . . .
Blue Buffalo . . . . . . . . . . . . .
Eukanuba . . . . . . . . . . . . . . .
Hill’s Ideal Balance . . . . . .
Hill’s Science Diet . . . . . . . .
Iams Healthy Naturals . . . . .
Other Iams . . . . . . . . . . . . . .
Kibbles ’n Bits. . . . . . . . . . . .
Nature’s Recipe . . . . . . . . . .
Nutro/Nutro Max . . . . . . . . . .
Ol’ Roy . . . . . . . . . . . . . . . . .
Pedigree . . . . . . . . . . . . . . . .
Pro Plan . . . . . . . . . . . . . . . .
Purina Beyond . . . . . . . . . . .
Purina Dog Chow . . . . . . . . .
Purina ONE . . . . . . . . . . . . .
Purina Puppy Chow . . . . . . .
Royal Canin . . . . . . . . . . . . .
Wellness . . . . . . . . . . . . . . . .
OTHER (Write In)
01
02
03
04
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
999
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
999
Your Household:
Used in
Pounds/
last 6
last 30
months
days
CAT LITTER
942
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Scoopable . . . . . . . . . . . . . .
Non-Scoopable . . . . . . . . . .
Crystals . . . . . . . . . . . . . . . .
KINDS:
Natural . . . . . . . . . . . . . . . . .
Regular (non-natural) . . . . .
BRANDS:
Arm & Hammer . . . . . . . . . . .
Blue Naturally Fresh . . . . . . .
Cat’s Pride . . . . . . . . . . . . . .
Dr. Elsey’s Precious Cat . . . .
Feline Pine . . . . . . . . . . . . . .
Fresh Step . . . . . . . . . . . . . .
Scoop Away . . . . . . . . . . . . .
Special Kitty . . . . . . . . . . . . .
Swheat Scoop . . . . . . . . . . .
Tidy Cats . . . . . . . . . . . . . . .
World’s Best . . . . . . . . . . . . .
OTHER (Write In)
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
999
How often do you
feed your cat the
following?
CAT
FEEDINGS
Your Household:
Used in Containers/
last 6
last 7
months
days
944
00
CANNED/WET
CAT FOOD
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Flat Can - 6 oz.. . . . . . . . . . .
Flat Can - 3 oz. pull top . . . .
Tall Can. . . . . . . . . . . . . . . . .
Pouch . . . . . . . . . . . . . . . . . .
Plastic Container/Tub . . . . . .
BRANDS:
Blue Buffalo . . . . . . . . . . . . .
Fancy Feast . . . . . . . . . . . . .
Friskies . . . . . . . . . . . . . . . . .
Hill’s Ideal Balance . . . . . . . .
Iams . . . . . . . . . . . . . . . . . . .
Meow Mix . . . . . . . . . . . . . . .
Nature’s Recipe . . . . . . . . . .
9Lives . . . . . . . . . . . . . . . . . .
Pro Plan . . . . . . . . . . . . . . . .
Purina Beyond . . . . . . . . . . .
Sheba. . . . . . . . . . . . . . . . . .
Wellness . . . . . . . . . . . . . . . .
Whiskas . . . . . . . . . . . . . . . .
OTHER (Write In)
PACKAGED DRY
CAT FOOD
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
999
Your Household:
Used in
Pounds/
last 6
last 30
months
days
945
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Blue Buffalo . . . . . . . . . . . . .
Fancy Feast Gourmet. . . . . .
Friskies . . . . . . . . . . . . . . . . .
Hill’s Ideal Balance . . . . . . . .
00
01
02
03
04
05
Iams Healthy Naturals . . . . .
Other Iams . . . . . . . . . . . . . .
Kit & Kaboodle . . . . . . . . . . .
Meow Mix . . . . . . . . . . . . . . .
Naturals from Cat Chow . . . .
06
07
08
09
10
Nature’s Recipe . . . . . . . . . .
9Lives . . . . . . . . . . . . . . . . . .
Nutro. . . . . . . . . . . . . . . . . . .
Pro Plan . . . . . . . . . . . . . . . .
Purina Beyond . . . . . . . . . . .
11
12
13
14
15
Purina Cat Chow . . . . . . . . .
Purina Kitten Chow. . . . . . . .
Purina ONE . . . . . . . . . . . . .
Royal Canin . . . . . . . . . . . . .
Wellness . . . . . . . . . . . . . . . . Whiskas . . . . . . . . . . . . . . . . Store’s Own Brand . . . . . . . . 16
17
18
19
20
21
22
23
999
OTHER (Write In)
CAT TREATS
Your Household:
Used in
Packages/
last 6
last 30
months
days
943
How often do you
feed your dog the
following?
DOG
FEEDINGS
940
946
Canned/
Wet
Dry Biscuits/
Food Food Treats
2 or more times a day . .
Once a day. . . . . . . . . . .
Occasionally. . . . . . . . . .
Never . . . . . . . . . . . . . . .
1
2
3
01
02
03
04
Canned/
Wet
Dry
Food Food
2 or more times a day . .
Once a day. . . . . . . . . . .
Occasionally. . . . . . . . . .
Never . . . . . . . . . . . . . . .
Treats
1
2
3
01
02
03
04
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Friskies . . . . . . . . . . . . . . . . .
Greenies. . . . . . . . . . . . . . . .
Meow Mix . . . . . . . . . . . . . . .
Pounce . . . . . . . . . . . . . . . . .
Whisker Lickin’s . . . . . . . . . .
Whiskas Temptations . . . . . .
OTHER (Write In)
00
01
02
03
04
05
06
07
999
HOUSEHOLD PRODUCTS
CHARCOAL
Your Household:
Used in
Bags/
last 12
last 12
months
months
INDOOR
INSECTICIDES
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Regular. . . . . . . . . . . . . . . . .
Instant Lighting. . . . . . . . . . .
Hardwood/Lump . . . . . . . . . .
KINDS:
Mesquite. . . . . . . . . . . . . . . .
Hickory . . . . . . . . . . . . . . . . .
Regular. . . . . . . . . . . . . . . . .
BRANDS:
Duraflame. . . . . . . . . . . . . . .
Kingsford (Regular) . . . . . . .
Kingsford Matchlight. . . . . . .
Royal Oak. . . . . . . . . . . . . . .
OTHER (Write In)
00
01
02
03
04
05
06
07
08
09
10
11
999
Your Household:
Used in
Times/last
last 12
30 days
months
(in season)
948
TOTAL: . . . . . . . . . . . . . . . . .
KINDS:
Aerosol . . . . . . . . . . . . . . . . .
Citronella Candle . . . . . . . . .
Coils . . . . . . . . . . . . . . . . . . .
Fan . . . . . . . . . . . . . . . . . . . .
Lamps/Lanterns. . . . . . . . . .
Lotion/Oil/Cream/Gel . . . . .
Pump . . . . . . . . . . . . . . . . . .
Towelettes. . . . . . . . . . . . . . .
BRANDS:
Avon Skin-So-Soft Bath Oil. .
Avon Skin-So-Soft Bug
Guard Plus . . . . . . . . . . . .
Bull Frog . . . . . . . . . . . . . . . .
Cutter (Regular) . . . . . . . . . .
Cutter Citronella Candle . . . .
00
01
02
03
04
05
06
07
08
14
15
16
17
18
Off! Mosquito Coil . . . . . . . . . Repel . . . . . . . . . . . . . . . . . . 19
20
999
Off! Active . . . . . . . . . . . . . . .
Off! Citronella Candle . . . . . .
Off! Deep Woods . . . . . . . . .
Off! Explore . . . . . . . . . . . . .
Off! Family Care . . . . . . . . . .
Flea & Tick Killers. . . . . . . . .
Flying Insect Killers . . . . . . .
Roach Baits/Traps . . . . . . . .
BRANDS:
Amdro . . . . . . . . . . . . . . . . .
Bayer Advanced . . . . . . . . .
Black Flag Ant & Roach . . . .
Black Flag Roach Motel . . . .
Other Black Flag. . . . . . . . . .
Combat Source Kill Ant Baits
Combat Source Kill Roach
Baits . . . . . . . . . . . . . . . . .
Other Combat Baits . . . . . . .
Hot Shot . . . . . . . . . . . . . . . .
Ortho Home Defense Max . .
Other Ortho . . . . . . . . . . . . .
Raid Ant & Roach Spray. . . .
Raid Ant Baits. . . . . . . . . . . .
Raid Flea Killer. . . . . . . . . . .
Raid Indoor Fogger . . . . . . .
Raid Roach Baits . . . . . . . . .
Raid Max Bug Barrier. . . . . .
Other Raid . . . . . . . . . . . . . .
Spectracide . . . . . . . . . . . . .
Terro . . . . . . . . . . . . . . . . . . .
OTHER (Write In)
10
11
12
13
INDOOR PLANT
FOOD
Your Household:
Used in
Containers/
last 6
last 6
months
months
949
TOTAL: . . . . . . . . . . . . . . . . .
KINDS:
Concentrates . . . . . . . . . . . .
Flying Insect Killers . . . . . . .
Hose Attachments . . . . . . . .
Liquids . . . . . . . . . . . . . . . . .
Outdoor Foggers . . . . . . . . .
Powders/Granules . . . . . . . .
BRANDS:
Amdro . . . . . . . . . . . . . . . . . .
Bayer Advanced . . . . . . . . . .
Black Flag. . . . . . . . . . . . . . .
Combat. . . . . . . . . . . . . . . . .
Hot Shot . . . . . . . . . . . . . . . .
Ortho . . . . . . . . . . . . . . . . . .
Raid Wasp & Hornet Killer . .
Raid Yard Guard . . . . . . . . . .
Other Raid . . . . . . . . . . . . . .
Spectracide . . . . . . . . . . . . .
00
01
02
03
04
05
06
Terro . . . . . . . . . . . . . . . . . . . 07
08
09
10
11
12
13
14
15
16
17
999
00
01
02
03
04
05
06
07
BRANDS:
Elmer’s . . . . . . . . . . . . . . . . .
Gorilla Glue . . . . . . . . . . . . .
Krazy Glue . . . . . . . . . . . . . .
Loctite. . . . . . . . . . . . . . . . . .
Super Glue . . . . . . . . . . . . . .
OTHER (Write In)
09
10
13
14
15
16
TOTAL:
19
REMOVABLE SELFSTICK NOTES
Sylvania . . . . . . . . . . . . . . . . Westinghouse. . . . . . . . . . . . OTHER (Write In)
05
999
00
01
02
999
Your Household:
Used in
Packages/
last 6
last 6
months
months
955
TOTAL: . . . . . . . . . . . . . . . . . 00
23
24
25
PLASTIC
PRODUCTS
26
27
Does your household use plastic products?
28
956-0
999
Yes 00
01
02
Used For:
Food Storage . . . . . . . . . . . .
Home Organizing/Storage . .
Bath . . . . . . . . . . . . . . . . . . .
Sinkware. . . . . . . . . . . . . . . .
Tabletop . . . . . . . . . . . . . . . .
Kitchen Gadgets. . . . . . . . . .
Recycling/Refuse Bins . . . . .
Cosmetics. . . . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . .
1
2
3
4
5
6
7
8
9
0
999
CHARCOAL
LIGHTER FLUID
Your Household:
Used in
Containers/
last 12
last 12
months
months
957
TOTAL:
04
OTHER (Write In)
22
952
03
Your Household:
Used in
Rolls/
last 6
last 6
months
months
21
Your Household:
Used in
Bulbs/
last 6
last 6
months
months
01
02
BRANDS:
Scotch Magic Transparent . . Scotch Pop-Up Tape. . . . . . . 20
Your Household:
Used in
Containers/
last 6
last 6
months
months
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Decorative . . . . . . . . . . . . . .
Energy Saving/Efficient . . . .
Outdoor . . . . . . . . . . . . . . . .
KINDS:
Regular. . . . . . . . . . . . . . . . .
Soft White . . . . . . . . . . . . . . .
Three-Way . . . . . . . . . . . . . .
BRANDS:
Cree . . . . . . . . . . . . . . . . . . .
GE Energy Smart . . . . . . . . .
GE Reveal . . . . . . . . . . . . . .
Other GE . . . . . . . . . . . . . . .
Philips. . . . . . . . . . . . . . . . . .
................. 17
18
00
954
11
12
OTHER (Write In)
LIGHT BULBS
Your Household:
Used in
Packages/
last 6
last 6
months
months
................. TRANSPARENT TAPE
TOTAL: . . . . . . . . . . . . . . . . . BRANDS:
Miracle Gro. . . . . . . . . . . . . . Schultz . . . . . . . . . . . . . . . . . TOTAL:
08
951
OTHER (Write In)
OTHER (Write In)
GLUE
953
TOTAL: . . . . . . . . . . . . . . . . .
KINDS:
Ant Baits/Traps. . . . . . . . . . .
Ant & Roach Aerosols. . . . . .
Ant & Roach Liquids . . . . . . .
Gels . . . . . . . . . . . . . . . . . . .
Indoor Foggers . . . . . . . . . . .
09
OUTDOOR
INSECTICIDES
Your Household:
Used in
Containers/
last 6
last 6
months
months
950
947
INSECT
REPELLENTS
Page 114
00
01
02
03
04
................. BRANDS:
Gulf Lite . . . . . . . . . . . . . . . .
Kingsford . . . . . . . . . . . . . . .
Royal Oak. . . . . . . . . . . . . . .
OTHER (Write In)
05
06
FIRELOGS
07
................. TOTAL:
10
BRANDS:
Duraflame. . . . . . . . . . . . . . . StarterLogg . . . . . . . . . . . . . 13
999
03
04
999
Your Household:
Used in
Logs
last 12
last 12
months
months
09
12
01
02
958
08
11
00
OTHER (Write In)
00
01
02
999
BABY/CHILDREN’S PRODUCTS
Page 115
BABY FOODS
Your Household:
Used in
Containers/
last 6
last 7
months
days
959
TOTAL:
TYPES:
Baby juice. . . . . . . . . . . . . . .
First Foods/Stage 1. . . . . . .
Second Foods/Stage 2 . . . .
Third Foods/Stage 3. . . . . . .
Snacks . . . . . . . . . . . . . . . . .
BRANDS:
Beech-Nut . . . . . . . . . . . . . .
Earth’s Best . . . . . . . . . . . . .
Gerber . . . . . . . . . . . . . . . . .
Gerber Graduates . . . . . . . .
Gerber Organic. . . . . . . . . . .
00
01
02
03
04
06
07
08
09
10
11
999
OTHER (Write In)
Your Household:
Used in
Packages/
last 6
last 30
months
days
960
................. BRANDS:
Beech-Nut . . . . . . . . . . . . . . Earth’s Best . . . . . . . . . . . . . Gerber . . . . . . . . . . . . . . . . . 00
01
02
03
999
Your Household:
Used in
Times/
last 6
last 7
months
days
BABY BATH,
WASH & SOAP
................. 00
02
03
KINDS:
Milk Based . . . . . . . . . . . . . . Soy Based . . . . . . . . . . . . . . Other . . . . . . . . . . . . . . . . . . 04
05
06
BRANDS:
Enfamil . . . . . . . . . . . . . . . . .
Enfagrow . . . . . . . . . . . . . . .
Gerber Good Start . . . . . . . .
Similac . . . . . . . . . . . . . . . . .
07
08
09
10
11
OTHER (Write In)
BABY NURSERS/
BOTTLES
01
999
Your Household:
Number
Used in
bought
last 6
last
months
30 days
00
01
02
03
04
05
06
07
NUK . . . . . . . . . . . . . . . . . . . Playtex . . . . . . . . . . . . . . . . . 08
09
999
OTHER (Write In)
999
Your Household:
Used in
Times/
last 6
last 7
months
days
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Bar . . . . . . . . . . . . . . . . . . . .
Liquid . . . . . . . . . . . . . . . . . .
BRANDS:
Aveeno . . . . . . . . . . . . . . . . .
Baby Magic. . . . . . . . . . . . . .
Burt’s Bees. . . . . . . . . . . . . .
Gentle Naturals
Eczema Baby Wash . . . . .
Johnson’s Baby Bar Soap . .
00
01
03
Burt’s Bees. . . . . . . . . . . . . .
Desitin . . . . . . . . . . . . . . . . .
Dr. Smith’s . . . . . . . . . . . . . .
Triple Paste. . . . . . . . . . . . . .
Vaseline Petroleum Jelly. . . .
OTHER (Write In)
BABY LOTION
04
05
Johnson’s Baby Bath . . . . . . Johnson’s Head-To-Toe
Baby Wash . . . . . . . . . . . . Other Johnson’s Baby Wash 02
06
07
08
09
10
999
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Aussie Kids. . . . . . . . . . . . . .
Aveeno . . . . . . . . . . . . . . . . .
Baby Magic. . . . . . . . . . . . . .
Johnson’s . . . . . . . . . . . . . . .
L’Oréal Kids . . . . . . . . . . . . .
DISPOSABLE
DIAPERS/
UNDERPANTS
00
Suave Kids . . . . . . . . . . . . . . 01
02
03
04
05
06
999
OTHER (Write In)
BABY OIL
Your Household:
Used in
Times/
last 6
last 7
months
days
967
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Baby Magic. . . . . . . . . . . . . .
Burt’s Bees. . . . . . . . . . . . . .
Johnson’s Baby Oil . . . . . . . .
Johnson’s Baby Oil Gel . . . .
Johnson’s Creamy Baby Oil .
00
01
02
03
04
05
06
07
08
09
10
999
00
02
01
03
04
05
999
970
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
GoodNites Underpants. . . . .
Huggies Little Movers . . . . . .
Huggies Little Movers
Diaper Pants . . . . . . . . . . .
Huggies Little Snugglers. . . .
Huggies Little Swimmers . . .
00
02
Huggies Overnites . . . . . . . .
Huggies Pull-ups . . . . . . . . .
Huggies Snug & Dry. . . . . . .
Luvs . . . . . . . . . . . . . . . . . . .
Pampers Baby Dry . . . . . . . .
Pampers Cruisers. . . . . . . . .
Pampers Easy Ups. . . . . . . .
Pampers Splashers . . . . . . .
Pampers Swaddlers . . . . . . .
COTTON SWABS
999
OTHER (Write In)
01
OTHER (Write In)
05
06
01
02
Your Household:
Used in
Packages/
last 6
last 30
months
days
03
04
969
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Aveeno . . . . . . . . . . . . . . . . .
Baby Magic. . . . . . . . . . . . . .
Burt’s Bees. . . . . . . . . . . . . .
Gentle Naturals
Eczema Baby Cream . . . .
Johnson’s . . . . . . . . . . . . . .
OTHER (Write In)
Your Household:
Used in
Times/
last 6
last 7
months
days
00
Your Household:
Used in
Times/
last 6
last 7
months
days
OTHER (Write In)
Store’s Own Brand . . . . . . . . 962
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Firm plastic. . . . . . . . . . . . . .
Disposable . . . . . . . . . . . . . .
BRANDS:
Avent . . . . . . . . . . . . . . . . . .
Dr. Brown’s . . . . . . . . . . . . . .
Evenflo . . . . . . . . . . . . . . . . .
MAM. . . . . . . . . . . . . . . . . . .
Munchkin Latch . . . . . . . . . .
Your Household:
Used in
Times/
last 6
last 7
months
days
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
A+D ..................
Aquaphor Baby. . . . . . . . . . .
Aveeno . . . . . . . . . . . . . . . . .
Balmex . . . . . . . . . . . . . . . . .
Boudreaux’s Butt Paste . . . .
966
TYPES:
Ready-to-feed. . . . . . . . . . . . Concentrated liquid (dilute
with water) . . . . . . . . . . . . Powder (dilute with water) . . 01
02
964
BABY SHAMPOO
961
TOTAL:
00
OTHER (Write In)
OTHER (Write In)
PREPARED INFANT
FORMULA
BABY OINTMENTS
AND CREAMS
968
TOTAL: . . . . . . . . . . . . . . . . . BRANDS:
Baby Orajel. . . . . . . . . . . . . . Hyland’s Baby. . . . . . . . . . . . 05
Plum Organics . . . . . . . . . . . TOTAL:
Your Household:
Used in
Times/
last 6
last 7
months
days
963
................. INFANT CEREAL
TEETHING REMEDIES
03
04
05
06
07
08
09
10
11
12
13
14
15
999
Your Household:
Used in
Times/
last 6
last 7
months
days
971
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Johnson’s . . . . . . . . . . . . . . .
Q-Tips. . . . . . . . . . . . . . . . . .
OTHER (Write In)
00
01
02
03
04
999
BABY/CHILDREN’S PRODUCTS
PRE-MOISTENED
BABY/CHILDREN’S
WIPES
Your Household:
Used in
Times/
last 6
last 7
months
days
PAIN RELIEVERS &
FEVER REDUCERS
FOR CHILDREN
972
TOTAL:
................. Pampers Baby Fresh . . . . . .
Pampers Kandoo . . . . . . . . .
Pampers Natural Clean . . . .
Pampers Sensitive . . . . . . . .
Wet Ones . . . . . . . . . . . . . . .
00
01
02
03
04
05
06
08
999
OTHER (Write In)
973
................. 00
TYPES:
Corn Starch . . . . . . . . . . . . . Talcum . . . . . . . . . . . . . . . . . 01
03
06
07
Store’s Own Brand . . . . . . . . 999
08
OTHER (Write In)
Your Household:
Bought
Now
in last
owns
6 months
974
1
2
Activity Mat . . . . . . . . . . . . . .
Baby carrier (front or back) . .
Baby car bed . . . . . . . . . . . . .
Baby car seat . . . . . . . . . . . .
Bathing/dressing table . . . . .
Baby bath tub . . . . . . . . . . . .
Baby mobiles . . . . . . . . . . . . .
Baby monitor . . . . . . . . . . . . .
Baby rattles . . . . . . . . . . . . . .
Bouncer seat . . . . . . . . . . . . .
Breast pump . . . . . . . . . . . . .
Cloth Diapers . . . . . . . . . . . .
Crib mattress . . . . . . . . . . . . .
High chair . . . . . . . . . . . . . . .
Infant crib . . . . . . . . . . . . . . .
Infant swing . . . . . . . . . . . . . .
Jump seat . . . . . . . . . . . . . . .
Juvenile bed . . . . . . . . . . . . .
Nursing pillow . . . . . . . . . . . .
Playpen . . . . . . . . . . . . . . . . .
Stroller. . . . . . . . . . . . . . . . . .
Stuffed toys . . . . . . . . . . . . . .
Toilet chair . . . . . . . . . . . . . . .
Walker . . . . . . . . . . . . . . . . . .
_______________________
988-0
01
02
03
04
05
06
999
CHILDREN’S COLD
TABLETS & LIQUIDS
00
01
02
03
04
05
999
Your Household:
Used in
Times/
last 6
last 30
months
days
977
05
Write in amount
OTHER (Write In)
04
Total amount spent in past
6 months: $
00
Your Household:
Used in
Times/
last 6
last 30
months
days
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Children’s Mucinex . . . . . . . .
Delsym . . . . . . . . . . . . . . . . .
PediaCare. . . . . . . . . . . . . . .
Robitussin. . . . . . . . . . . . . . .
Triaminic . . . . . . . . . . . . . . . .
02
OTHER (Write In)
CHILDREN’S COUGH
SYRUP
976
Your Household:
Used in
Times/
last 6
last 7
months
days
BRANDS:
Burt’s Bees. . . . . . . . . . . . . .
Gold Bond Baby Powder . . .
Johnson’s Baby Powder–
Regular . . . . . . . . . . . . . . .
Pure Cornstarch . . . . . . . .
Medicated . . . . . . . . . . . . .
OTHER (Write In)
09
10
BABY FURNITURE &
EQUIPMENT
CHILDREN’S
CLOTHING
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Liquid . . . . . . . . . . . . . . . . . .
Tablet . . . . . . . . . . . . . . . . . .
BRANDS:
Children’s Allegra . . . . . . . . .
Children’s Benadryl Allergy. .
Children’s Claritin . . . . . . . . . .
Children’s Mucinex . . . . . . . . .
Children’s Zyrtec Allergy . . . . .
Dimetapp . . . . . . . . . . . . . . .
Hyland’s 4Kids . . . . . . . . . . .
PediaCare. . . . . . . . . . . . . . .
Robitussin . . . . . . . . . . . . . . .
Triaminic . . . . . . . . . . . . . . . .
Vicks Children’s NyQuil. . . . .
OTHER (Write In)
VITAMINS/
NUTRITIONAL
SUPPLEMENTS
FOR CHILDREN
25
00
01
02
03
04
05
06
07
08
09
10
11
12
13
OTHER (Write In)
Children 1-2 Years:
Jeans or Slacks . . . . . . . . . .
Outerwear. . . . . . . . . . . . . . .
Shorts. . . . . . . . . . . . . . . . . .
Sleepwear . . . . . . . . . . . . . .
Suits or Dresses . . . . . . . . . .
Sweatshirts/Sweatpants . . .
Tops/Shirts . . . . . . . . . . . . . .
Underwear (not diapers). . . .
Waterproof Pants . . . . . . . . .
Children 3-5 Years:
Jeans or Slacks . . . . . . . . . .
Outerwear. . . . . . . . . . . . . . .
Shorts. . . . . . . . . . . . . . . . . .
Sleepwear . . . . . . . . . . . . . .
Suits or Dresses . . . . . . . . . .
Tops/Shirts . . . . . . . . . . . . . .
Children 6-12 Years:
Jeans . . . . . . . . . . . . . . . . . .
Outerwear. . . . . . . . . . . . . . .
Shorts. . . . . . . . . . . . . . . . . .
Slacks. . . . . . . . . . . . . . . . . .
Sleepwear . . . . . . . . . . . . . .
24
25
26
27
28
Suits or Dresses . . . . . . . . . .
Sweaters. . . . . . . . . . . . . . . .
Tops/Shirts . . . . . . . . . . . . . .
Underwear . . . . . . . . . . . . . .
29
30
31
32
33
Amount Spent Last 6 Months
$50 or less . . . . . . . . . . . . . .
$51-$99 . . . . . . . . . . . . . . . .
$100-$199 . . . . . . . . . . . . . .
$200-$399 . . . . . . . . . . . . . .
$400 + . . . . . . . . . . . . . . . . .
CHILDREN’S SHOES
TOTAL:
00
01
02
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
980-0
1
2
3
4
5
Your Household:
Bought/
Pairs
last
bought/last
6 months
6 months
981
Your Household:
Used in
Times/
last 6
last 7
months
days
TOTAL: . . . . . . . . . . . . . . . . .
TYPES:
Chewable . . . . . . . . . . . . . . .
Liquid . . . . . . . . . . . . . . . . . .
BRANDS:
Boost Kid Essentials. . . . . . .
Centrum Kids . . . . . . . . . . . .
Disney Vitamins . . . . . . . . . .
Flintstones Vitamins . . . . . . .
Iron Kids . . . . . . . . . . . . . . . .
L’il Critters . . . . . . . . . . . . . . .
Pedialyte . . . . . . . . . . . . . . . .
PediaSure . . . . . . . . . . . . . . .
Poly Vi Sol (drops) . . . . . . . .
For Baby Under 1 Year:
Outerwear. . . . . . . . . . . . . . .
Sleepwear . . . . . . . . . . . . . .
Stretchies . . . . . . . . . . . . . . .
999
978
24
Your Household:
Bought in
Number
last
bought/last
6 months
6 months
979
TOTAL: . . . . . . . . . . . . . . . . .
BRANDS:
Children’s Advil . . . . . . . . . .
Infants’ Advil . . . . . . . . . . . . .
Children’s Motrin . . . . . . . . .
Children’s Tylenol Drops/
Liquid . . . . . . . . . . . . . . . .
Infants’ Tylenol . . . . . . . . . . .
PediaCare. . . . . . . . . . . . . . .
07
Store’s Own Brand . . . . . . . . TOTAL:
Your Household:
Used in
Times/
last 6
last 30
months
days
975
BRANDS:
Cottonelle . . . . . . . . . . . . . . .
Huggies Natural Care. . . . . .
Huggies One & Done . . . . . .
Other Huggies . . . . . . . . . . .
BABY POWDER
Page 116
03
04
05
06
07
08
09
10
11
12
999
................. TYPES:
Athletic . . . . . . . . . . . . . . . . .
Canvas . . . . . . . . . . . . . . . . .
Casual/leisure . . . . . . . . . . .
Dress . . . . . . . . . . . . . . . . . .
Leather . . . . . . . . . . . . . . . . .
Rain or Snow Boots. . . . . . . .
Sandals . . . . . . . . . . . . . . . .
Slippers . . . . . . . . . . . . . . . .
Western Boots . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . .
Bought for:
982-0
Child under 1 year . . . . . . . . 1
Child 1-5 years . . . . . . . . . . . 2
Child 6-12 years . . . . . . . . . . 3
Amount Spent Last 6 Months
$1-$25 . . . . . . . . . . . . . . . . .
$26-$50 . . . . . . . . . . . . . . . .
$51-$99 . . . . . . . . . . . . . . . .
$100-$199 . . . . . . . . . . . . . .
$200 + . . . . . . . . . . . . . . . . .
983-0
1
2
3
4
5
00
01
02
03
04
05
06
07
08
09
999
PLACE SAMPLE
LABEL HERE
INTERVIEWER: Please complete this page and use it as a voucher for cash payment.
RESPONDENT:
Ms.
Mr.
PRINCIPAL SHOPPER
Ms.
Mr.
ENTER ON PAGE 87
ADDRESS
CITY
STATE
TELEPHONE No.
SAMPLE ID No.
UPON RECEIPT OF CASH:
RESPONDENT SIGNATURE:
DATE:
INTERVIEWER SIGNATURE:
INTERVIEWER NAME:
INTERVIEWER PHONE No.
ZIP
American Institute of Consumer Studies
2 Campus Boulevard
Newtown Square, PA 19073
75

Product Booklet: Wave 75

Transcription

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