Please fill in the blanks or place an X or check mark next to the word or phrase that best matches your response.
Male Under 16
Female 17 – 25
26 – 35
36 – 50
51 – 65
Over 65
What is your marital status? How many children are there in your family?
Married 0
Widowed 1–2
Separated 3–4
Divorced 5–6
Single
Prefer not to say
How would you describe your race or ethnicity What is your highest level of education?
$175,001 – $200,000
Over $200,000
In which of the following areas do you live? What type of internet connection do you have?
T1 or faster
None
Other
How comfortable are you using a computer? How long have you been using the internet?
How often do you use the internet? How would you describe your proficiency on the internet?
Have you personally purchased anything from an internet What types of items do you purchase on the internet?
site in the last 6 months?
Yes Home appliances and accessories
Software
Music, CDs
Videos, DVDs
Electronics
Services
Clothing
Medications
Flowers
Others
Select an approximate amount you would spend on a single How often do you cook at home?
online purchase:
$5 – $50 Rarely
$51 – $100 2 – 3 days a week
Do you consider yourself a gourmet cook? Have you ever purchased cooking appliances from an
internet site?
Yes Yes
No No
How often do you order merchandise through an online site How often have you purchased cooking appliances and
for delivery to your door? other kitchen accessories on the internet?
Never Once
Rarely 1 – 3 times
Occasionally 4 – 6 times
Often More than 6 times
Very Frequently
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