PLEASEDETACHHEREBEFOREMAILING.
polkaudio
the speaker specialists’
Thankyoufor your purchase.Weat PolkAudiofeelyou arethe most important
personin ourcompany. Yourfeedbackwill helpus in our ongoingeffortsto producethefinest and most
satisfying loudspeakeravailable.
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IFirst Name: Initial: Last Name: A
---.- . ~~ Ai
Address: (Number and Street) Apt #:
I- ~- .~ ~. 1 -~1-- I---
City: State: Zip Code:
! 1
Phone#:
1 ~ L~-~IL
E-mail Address:
Ifyouvoluntarilyprovideuswithyouremailaddress,yougiveuspermissiontoshareanduseyouremailaddressto sendyouemailoffersthatmayinterestyou.
(EXAMPLE:yourname9yourhost.com)
Dateof Purchase: Tb!-A 1~-
Day
Store Name: Year -
im
;!g;taled this product? 3. 0 Friend/ Relative
2. 0 Professional
16
Didthe following reasons influence your purchase of
this PolkAudio product? &s No
1. PolkAudioReputation
2. Easeof Use : i
3. Appearance
4. Recommendationof Dealer
17
5. Recommendationof Family/Friend
6. MagazineReview i ::
7. Qualityof Sound
8. TechnicalSpecifications : I2
9. Valuefor Price
10. PriorExperiencewith PolkAudio : :
Wherehaveyou seen Polk products featured? (Checkall that apply)
19
1. 0 Magazineadvertisement 4. 0 In-store advertising
2. 0 Polk literature 5. 0 Someoneelse’s home or car
3. 0 Magazinereview 6. 0 On-line computer bulletins
What other brands did you consi,drrCzFk allthat apply)
20
1. 0 Nootherbrands
2. 0 Advent 14. 0 Kenwood
3. Cl Alpine 15. 0 Kicker
4. 0 Altec 16. 0 MBQuart
5. 0 BostonAcoustics 17. 0 MTX
6. 0 Canton 18. 0 Pioneer
7. 0 Cenuin-Vega 19. 0 RockfordFosgate
8. 0 Clarion 20. 0 Sony
9. 0 Infinity 21. 0 Soundstream
10. 0 JBL 22. 0 Other
11. 0 Jensen
In what automobile will this Polk Audio product be installed?
21
Make: ~~ - ~~.~~
EXAMPLE:FORD
Model: ~~~ ~. ~
EXAMPLE:MUSTANG
Year: k-.
EXAMPLF 1965
Yourgender: 1. 0 Male 2. 0 Female
Yourmarital status: 1. 0 Married 2. 0 Single
Dateof y@~ birth:
i-
~~~
Month Day ye.5
Dateof birth (month/year) of the other adults and
children in your household:
MaleFemale
Male Female
1.0 2. 0 1.0 2. 0,
MO",h Yeal MO",h
1.0 2. 0 1.02.0 i'
Mcm,h Yeal MO",h
22
-I
locatedonUPCbarfoundon
productcarton(Seeexample)
lncludina vourself, what is the &t&l number of people
living in your household?
(Examples:01,02,03,04...)d
F”::y~oprmary~~Rcejdo you:
Which best describes your family income?
1. Cl Under$15,000 7. 0 $1oo,ooo-$124,999
2. 0 $15,000-$24,999 8. 0 $125,000-$149,999
3. 0 $25,000-$34,999 9. 0 $150,000-$174,999
4. 0 $35,000-$49,999 10. cl $175,000-$199,999
5. 0 $50.000-$74.999 11. 0 $200.000-$249.999
6. 0 $75:000-$G99:999
Education:
12. Cl $250;000or over
(Pleasecheckwhichcategoryappliesto you):
1. 0 Somehighschool 3. 0 Collegedegree
2. 0 Completedhighschool 4. 0 Graduatedegree
In the last six (6) months has anyone in your household
purchased any of the following items through the mail
and/or over the internet?
1. Books/magazines A2l B.Internet
2. Children’sproducts i
3. Clothes :
4. Insurance/financialproducts i
5. Music/video/DVD :
6. Travel :
7. Other : cl
I usethese credit cards:
1, 0 AmericanExpress
2. 0 Gas/Retail
3. 0 MasterCard
4. 0 Visa
5. Cl Other
6. Cl Donot havecreditcards
3. 0
4. 0
5. 0
6. 0
7. 0
a. 0
9. 0
10. 0
11. 0
12. 0
13. 0
14. 0
15. 0
16. 0
17. 0
18. 0
Someonein my home participates in
(Checkallthat apply)
1, 0 Automotivework 19.
2. 0 Bible/devotional 20.
Boating/sailing 21.
Camping/hiking 22.
Casinogambling 23.
Conbibutetocharitablecauses24.
Crafts 25.
Culturalart/events 26.
Cycling 27.
Do-it-vourself 28.
Enter&&stakes/contests 29. 0 Selfimprokment
Fishing 30. 0 Soccer
Fitness/exercise/jogging 31. 0 Tennis
Gardening 32. 0 Travel-Foreign
Golf 33. 0 Travel-U.S
Gourmetcooking/food/wines34. 0 lV shopping
Grandchildren 35. 0 Vitamins/naturalfoods
Homedecorating 36. 0 WatchsportsonTV
the
Hunting/Shooting
Ime& (mm funds,I&)
Investments(stocks&bonds)
Moviewatching
Owna cat
Ownadog
Personalcomputing/