Modern Betty

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Cleaning Survey about Green Cleaning Products

I am conducting a survey consisting of 10 quesitons about Green Products to determine Modern Betty's Demographic! Your participation matters and is greatly appreciated as I require several hundred responses!

Please help me by filling out the survey below!

Results will be posted in March 2010!

Green Cleaning Products

Please note that all fields followed by an asterisk must be filled in.

Are you:

	Male
	Female

What is your age group:

	20-25
	26- 30
	31-35
	36-40
	41-45
	46-50
	51-55
	56-60
	61-65
	65+

Where do you work?

	Outside your home.
	Home Business.
	Stay at Home Parent.

Do you have children or pets?

	Yes
	No

Where do you purchase your “Green” Cleaning Products? (Check all that apply)

	Grocery Store
	Hardware Store
	Department Store
	Natural Health Food Store
	Specialty
	Make my own
	Do not use
	Other

How often do you purchase “Green” Cleaning Products?

	1-10 / year
	11-15 / year
	16-20 / year
	21+ / year

How many “Green” Household Cleaners do you currently have in your home?

	1-2
	3-5
	5-10
	10+

Where do you look for information when considering purchasing “Green” Cleaning Products? (Check all that apply)

	Internet
	Television
	Trade Shows
	Flyers
	Store Shelves
	Magazines
	Friends / Family
	Other

What is the most important feature when purchasing a “Green” Cleaning Product? (Check all that apply)

	Low Price
	Advertising / Appearance
	Ingredients
	Effectiveness
	Fragrance
	Safety (Health & Environment)
	Convenience

Do you or does someone in your family suffer from one of the following? (Check all that apply)

	Allergies
	Asthma
	Heart Condition
	Crohn’s / Colitis
	Cancer
	Arthritis
	ADD / ADHD

First Name*
First Name*

E-mail Address*
E-mail Address*

City*
City*

State/Prov*
State/Prov*

Country

Home Phone

Please enter the word that you see below.