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Name
   
Gender (Male / Female)
   
Age
   
Race
   
Date of birth
   
Contact number
   
Email
   
Address
   
 
 
 
What is your highest academic qualification?
   
What is your current occupation?
   
What is your estimate annual income?
   
What is your current marital status? (Married / Divorced / Separate / Widowed / Single)
   
How many Children do you have?
   
How many family members are living together with you?
   
 
 
 
What types of credit cards do you have (Select all that apply)?
 
Visa
 
Mastercard
 
American Express
 
Other
 

 
 
 
Do you own a car?
 
Yes
 
No
 
If yes, please specify Car Type & Brand.
 
 
 
 
What is the estimate amount your household spend on drinks & beverages per month?
 
Less than $100
 
$100 - S200
 
$200 - S300
 
$400 & above
 
 
 
What is the estimate total of your household income?
 
Less than $2000
 
S2000 - $5000
 
$5000-$9000
 
$9000 & above