Respondent Entry Form

Sexual Orientation

Marital Status

Age of Spouse?

Do you have children? No 1 2 3 4 5

Are You The Head Of Household?

Employment Status

Household Annual Income

Education

What is your race?

American Indian or Alaskan Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
Hispanic or Latino
White

Were you born in the USA? Yes No

Were you raised in the USA Yes No

How long have you lived in the USA?

Are you bilingual? Yes No

Do you own a car? Yes No

Do you travel? Yes No

Do you travel by Plane? Yes No

Have you used any of the following airlines?

Aerocaribe
Aerogal
Aerolineas Argentinas
AeroMexico
Aeroperlas
Air Aruba
Air Jamaica
Air Saint-Barthelemy
AirTran
American Airlines
Bahamas Air
Caribbean Airlines
Cayman Airways
Continental

Delta
JetBlue
LAN Airlines
Lynx Air International
Maya Airways
Mexicana Airlines
Northwest Airlines
Southwest Airlines
Spirit Airlines
TAM Linhas Aeras
Travelair Costa Rica
United Airlines
US Airways

Other

Do you travel by Train? Yes No

Have you used any of the following Train Lines?

AMTRAK Acela
Other

Do you travel by Ship? Yes No

Have you used any of the following Cruise Lines?

Royal Carribean Princess Carnival Disney
Other

Do you travel by Bus? Yes No

Do you smoke? Yes No

Do you have a family doctor? Yes No

Do you suffer from any chronic illnesses? Yes No

Do you have any allergies? Yes No

Do you use any of these Money/Wire Transfer Services? *

Dolex
La Nacional
MoneyGram
Quisquellana
Ria Envia
Vigo
Western Union
Xoom

Other

Which of these toothpaste(s) do you use?

Aim
Aquafresh
Arm & Hammer
Close-Up
Colgate
Crest
Kirkland
Mentadent
Pepsodent
Sensodyne

Tom's of Maine
Ultra Brite

Other

Which house cleaning products do you use?

Fabuloso
Fantastic
Green Works
Lestoil/Lysol
Method
Mistolin
Pine Sol
Pledge
Resolve
Scotch-Brite

Seventh Generation
Swifter
Windex

Other

Which brands of paper towels do you use?

Bounty
Brawny
Charmin
Fiesta
Kirkland
Marcal
Mardi Gras
Nature's Choice
Scott
Seventh Generation

Sparkle
Target
Viva
Walmart

Other