Cooper Symons & Associates

Small Business Owner/Managers.
GET PAID $$$ FOR YOUR OPINIONS

Small businesses are becoming an increasingly important market for everything from office equipment, telecommunications, banking, insurance, travel, government legislation, cars etc. We are getting more and more requests to organise group discussions and one on one interviews, with small business owners.

Why should you register?

Our experience is that informal afterhours discussion groups session are an excellent way to find out whats happening in the marketplace, and how other small business owner/managers operate their businesses.

We organise interviews and 1-2 hour discussion groups. Come along and have your say, refreshments are always served. Owner/Managers generally receive a cash payment of $100.00 (and sometimes more) as a "gesture of thanks" for attending.

Register NOW by completing & submitting the questionnaire below. We will periodically email or phone you to see if you are suitable for current project.

	This questionnaire should be filled out by any person over 15 years of age who is interested in attending MR groups, interviews and clinics.

	Where do you live: ? * (* indictaes required fields)

1.	First Name :	*
2.	Surname :	Title: *
	Add/Update Information ?	*
3.	Address :	(optional)
	Suburb:	*
	Postcode :	State : *
		...
4.	Telephone - Home :	(include area code) *
	Telephone - Work :	(include area code) *
	Telephone - Mobile :	* Plan:
		Mobile Provider:
5.	Email Address :	* * We may email you from time to time regarding groups, enter 'OPT OUT' in the Email Address if you do not wish this to happen.
	Email Check Frequency :	*
		...
6.	Your Gender :	*
	What is your marital status :	*
	Country of birth :	*
	Date of birth :	Day (01-31) / Month (01-12) / Year (1900-) *
		...
7.	Employee: Job Title	(10 characters max.) *
	Employed Status :	*
	Self Employeed :	*
	Your occupation (ABS codes) :	*
	What Industry Type :	*
	Defined Occupation:	*
	Suburb in which you Work:	(postcode, please) *
	What is your partners occupation (if applicable)	*
		...
8.	Business Owners:
	Name of Business:	*
	Type:	*
	No. of Employees:	*
	Turnover:	*
	Main Business bank:	*
		...
9.	Credit cards held (choose whichever apply) :

10.	What bank do you have your main account with :
	What type of account(s) do you have?	Savings Account Cheque Investment
		...
11.	These questions relate to your main car(s):
	Car Make :
	Car Model :
	Year of Manufacturer :
	Car insured with :	(10 characters max.)
	Is this a company car :
		...
12.	Do you have pets (how many):	Cat Dog

13.	Do you have any children living at home, if so what is their year of birth :	Child BOY, year of birth (YYYY): Child BOY, year of birth (YYYY): Child BOY, year of birth (YYYY): Child GIRL, year of birth (YYYY): Child GIRL, year of birth (YYYY): Child GIRL, year of birth (YYYY): Interested in attending Groups/Interviews/Clinics ? :
		...
14.	Into which of the categories listed does the income of the entire household belong?
		...
15.	Do you smoke cigarettes :
	Do you have Pay TV :
	Do you have Private Health Insurance with :
	Do you have any Health Condition:
	Have you taken part in Market Research Groups/Interviews/Clinics before:
	Comments :



		Thank you

If you have friends interested in registering, please Click Here to send them an invitation email.

Member of the : AMSRS