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What state do you live in?
   
 
 
 
How many people occupy your household?
 
1
 
2
 
3
 
4
 
Other
 
 
 
 
Do you have children?
 
Yes
 
No
 
 
 
What cell phone service do you have?
 
AT&T
 
Verizon
 
Sprint
 
US Cellular
 
T Mobile
 
Other
 
 
 
 
What type of cell phone do you currently have? Include the maker of the cell phone and the type, if available.
   
 
 
 
Where did you buy you cell phone from?
 
Cell phone company store
 
Ebay
 
Craigslist
 
Other
 
 
 
 
If purchased from an online seller, did you recieve information on the seller? Did you keep it for your records?
   
 
 
 
What is you age range?
 
15-25
 
26-35
 
36-45
 
46-55
 
Other
 
 
 
 
 
 
Mr.
 
Mrs.
 
Miss
 
Other
 
 
 
 
Desired reward?
 
IPod Shuffle©
 
$100 Visa© Gift Card
 
$120 BP© Gas Card
 
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