First Name:
Last Name:
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We'd like to know more about you. Please take a moment to fill out our questionnaire. You may win a free spa treatment.
How did you hear about GENLUX?
How old are you?
under 21
21 - 34
34 - 45
over 45
Your profession?
Are you?
female
male
How often do you shop for fashion or accessories?
1 - 2 times a month
4 - 8 times per month
9 - 12 times per month
over 12 times per month
Your favorite places to shop?
Do you shop online? Which websites?
Your favorite designers?
How often do you dine out?
1 - 2 times per week
2 - 4 times per week
over 4 times per week
How many domestic trips do you take per year?
Business
0
1 - 6
6 -12
over 12
Pleasure
0
1 - 6
6 - 12
over 12
What kind of car do you drive?
What is your annual household income?
0 - $30.000
$30.000 - $75.000
$75.000 - $100.000
$100.000 - $200.000
over $200.000
What other interests do you have?
Do you have any comments?
