Please take the time to fill in your details and the following short survey.
 
TITLE


FIRST NAME
LAST NAME
EMAIL
ADDRESS
 
SUBURB/TOWN
POSTCODE
STATE  
COUNTRY
Age
 Day  Month  Year
(please enter your date of birth)
Income  
Gender Male Female  
 
 
When filling out the following questionnaire, please select the answer which describes your own personal situation most accurately.
 
1.
 Do you currently have or are you considering any of the financial products below?
(please tick all that apply)
   
 
Credit Card   Managed Funds
Gold Credit Card   Personal Loan
Home Loan   Professional Financial Planning
Income Protection Insurance   Self Managed Superannuation
Investment Loan   Stocks / Shares
2.
 Would you consider donating to any of the following charities?
     
 
Alzheimer’s Association   Salvation Army
Amnesty International   Spastic Centre
Anglicare   St Vincent de Paul
Red Cross   Smith Family
Royal Flying Doctors   World Wide Fund for Nature (WWF)
Fred Hollows Foundation   Benevolent Society
   
3.
 Would you like to buy discounted prescriptions and get free home / office delivery?
     
 
You  Partner 
   
4.
 What is the approximate value of all your investments?
     
 
Savings
Cheque
Passbook; Cash Management
Term Deposit; Shares
Managed Funds
   
5.
 Do you currently subscribe or would you consider subscribing to any of the following types of magazines?
 
Business   Home Decorating
Computing   Money/Investment
Cooking   Motoring
Current Affairs   Sport
Entertainment   Television
Gardening   Travel
Geographical   UK Magazines
Health   Other International
   
6.
 Which brand/s of Roast & Ground, or "real", coffee are served on a regular basis in your household?
   
 
Aurora Harris Lavazza
Melitta Robert Timms Vittoria
Other
   
7.
 In an average week, about how many cups of Roast & Ground, or "real", coffee would be served in your household?
   
 
   
8.
 Which video chain are you a member of? (Please tick all that apply)
     
 
Blockbuster Civic Movieland
Video Ezy Other
   
9.
 Would you consider purchasing window tint in the next 12 months?
     
 
   
10.
 Do you / your partner have or are you considering a cable / broadband / ADSL connection to the Internet?
   
 
You Partner