| Your Education |
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Annual household income |
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| Employment |
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| Job function/title |
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| Kind of job |
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| Where you work |
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| Retirement/Savings |
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| Health insurence |
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Do you have children under 18? |
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| Child 1: |
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| Child 2: |
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| Child 3: |
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| Child 4: |
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| Child 5: |
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| Child 6: |
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| Political affiliation |
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| Housing situation |
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| Kind of housing |
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| Internet provider? |
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| Do you travel often? |
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| Do you own any cars? |
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How did you hear about C & M Research? |
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| Page 2 |