Contact Information
First Name:*   Last Name:*
Address:*
City:*	Do Not Abbreviate
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If your State/Province is not in this list, enter it here:
Zip/Postal Code:*
County:     Country:* CanadaUnited KingdomUSA
Home Phone:*  Cell/Work Phone:1
Fax Number:    E-Mail:*
Where Can You Shop?
We are in need of shoppers all over the United States & Canada, at least on an occasional basis! In order for us to locate you in our database we need you to list the towns you can shop. Please list ALL towns you are willing to shop. Do not enter things like "Denver Metro Area", "surrounding area", or "50 mile radius", etc., or we won't be able to locate you. We search using specific town names. Please list towns here.
Previous Experience
From time to time we run pilot programs for our clients. We often use people with previous experience in a particular field to help with the pilot program.
Do you have any previous mystery shopping experience? Yes No
If 'Yes', please tell us what types of mystery shops you have experience doing. (i.e. Fine Dining, Casual Restaurants, Fast Food, Gas Stations, Automobile, Jewelry Stores, etc.)
Your Writing Skills
Our clients need well-written and highly detailed reports. Good writing skills are necessary to be a good mystery shopper. Including details in your writing is essential. Please provide us a sample of your writing skills by answering the following question. Your writing sample will be used to determine whether or not you are hired for mystery shopping assignments. Internet slang writing with incomplete sentences, all capitals, no capitals and/or punctuation will not be considered.
Write a minimum of 10 sentences describing a recent shopping or customer service experience. The experience may be either positive or negative and may be about any shopping experience you have had, not just mystery shopping experiences.*
Assignment Matching
From time to time our clients need shoppers that have certain demographics. By answering the following questions, you allow us to consider you for more shopping opportunities. This information is never shared, sold nor used for marketing purposes.
Birth Date: - -    Gender: FemaleMale
Occupation:	Professional/Technical Upper Management/Executive Middle Management Sales/Marketing Clerical/Service Worker Tradesman/Machine Operator/Laborer Caregiver/Homemaker Student Retired
Education:	High School Some College 2 Year Degree 4 Year Degree Masters Degree Ph.D. Technical Training
Household Income:	Under 15,000 15,000-19,999 20,000-29,999 30,000-39,999 40,000-49,999 50,000-59,999 60,000-74,999 75,000-99,999 100,000-124,999 125,000-149,999 150,000-174,999 175,000-199,999 200,000-249,999 250,000 and Over
For your primary residence, do you Own    Rent ?
Marital Status:	Married Single Divorced Widowed Common Law Engaged Committed Relationship
Please list the age and gender of EVERYONE living in your household. (Include children, parents, significant others, etc.)
Year of Birth   Gender       Age Gender 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900 FemaleMale            2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900 FemaleMale 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900 FemaleMale            2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900 FemaleMale 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900 FemaleMale            2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900 FemaleMale
Please list any memberships you hold. (shopping clubs, auto clubs, etc.)
Ethnicity: (mark all that apply)
Asian Caucasian African American Native American Hispanic Middle Eastern Other Prefer Not To Answer
Primary Language:	English Spanish French German Portuguese Chinese Japanese Korean Russian Other
Mark any second language that you SPEAK fluently:
English Spanish French German Portuguese Chinese Japanese Korean Russian Other
Please check all that apply to your household.
Member of a Frequent Flyer Program     Subscribe to an Online Service Own an IBM/IBM Compatible Computer Own an Apple/Macintosh Computer Donate to Charitable Causes Own a Laptop Computer Own a Cell Phone Catalog/Internet Shopping Own a CD Player/Writer Own a Digital Camera, Printer, Fax, Camera Phone Own a PDA, DVD Player/Writer
Please select the type of vehicles in your household.
Year Make Model Car 1   2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 AM General Acura Audi Bentley BMW Buick Cadillac Chevrolet Chrysler Daewoo Dodge Ferrari Ford GMC Honda Hyundai Infiniti Isuzu Jaguar Jeep Kia Land Rover Lexus Lincoln Mazda Mercedes-Benz Mercury Mitsubishi Nissan Oldsmobile Plymouth Pontiac Porsche Rolls-Royce Saab Saturn Subaru Suzuki Toyota Volkswagen Volvo Car 2   2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 AM General Acura Audi Bentley BMW Buick Cadillac Chevrolet Chrysler Daewoo Dodge Ferrari Ford GMC Honda Hyundai Infiniti Isuzu Jaguar Jeep Kia Land Rover Lexus Lincoln Mazda Mercedes-Benz Mercury Mitsubishi Nissan Oldsmobile Plymouth Pontiac Porsche Rolls-Royce Saab Saturn Subaru Suzuki Toyota Volkswagen Volvo Car 3   2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 AM General Acura Audi Bentley BMW Buick Cadillac Chevrolet Chrysler Daewoo Dodge Ferrari Ford GMC Honda Hyundai Infiniti Isuzu Jaguar Jeep Kia Land Rover Lexus Lincoln Mazda Mercedes-Benz Mercury Mitsubishi Nissan Oldsmobile Plymouth Pontiac Porsche Rolls-Royce Saab Saturn Subaru Suzuki Toyota Volkswagen Volvo
Survey Matching
From time to time our clients need shoppers to partake in surveys. By answering the following questions on your interests, you allow us to consider you for survey opportunities. This information is never shared, sold nor used for marketing purposes.
Please indicate the interests/activities in which you, your spouse, or your family participates in on a regular basis.
Bicycling     Golf     Veg. Gardening Snow Skiing     Tennis     Electronics Hunting/Shooting     Boating     Surf the 'Net Needlework     Sewing     Health Foods Crafts     Travel     Books Clothing     Knitting     Fishing Fine Arts     Science     Gambling Wine     Sports     Wildlife Collectibles     Antiques     Walking Real Estate     Coins     Horses Science Fiction     Stocks     Bonds Dogs     Cats     Birds/Reptiles/Rodents Physical Fitness/Exercise     Camping/Hiking Photography     Running/Jogging Grandchildren     Flower Gardening Automotive Work     Recreational Vehicles Bible/Devotional Reading     Attending Cultural Events Foreign Travel     Stamp Collecting Gourmet Cooking     Mutual Funds Our Nations' Heritage     Entering Sweepstakes Environmental Issues     Dieting/Weight Control New Technology     Self-Improvement Home Video Recording     Cruise Ship Vacations Home Workshop/Do-it-Yourself     Listen to Tapes/CD's/Records Money Making Opportunities     Buy PreRecorded Videos
One Last Question
Where did you hear about us? Search Engine Shopping Board/Other Website TV/Radio shows Magazines Word of Mouth/Friends Other
Other