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| * = required |
| *Name: |
Title
First
Middle Initial
Last
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| *Street Address: |
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| Street Address2: |
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| *City: |
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| *US State/Province: |
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| *Zip/Postal Code: |
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| *Email: |
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| *Date of Birth: |
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| Phone: |
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| Occupation: |
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*1. Gender: |
Male
Female
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| *2. Age: |
Under 25
25 - 34
35 - 44
45 - 54
55 - 64
65 and over
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| *3. Marital Status: |
Married
Single
Divorced/Widowed
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| *4. Type of Residence: |
Single family home
Apartment
Condominium
Other
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| 5. Children: Give number of children living at home by age category. |
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| 6. Annual combined family income: |
Under $25,000
$25,000 - $34,999
$35,000 - $44,999
$45,000 - $54,999
$55,000 - $74,999
$75,000 - $99,999
$100,000 - $149,999
$150,000 - $249,999
$250,000 +
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| 7. The following is a list of six purchase motivators that influence a purchase of home furnishings. Please rank each in order of importance to you in the purchase of this product with "1" being the most important and "6" being the least important. (Each influence must be given a number. Only use each number once.) |
Prestige of manufacturer or product made by the manufacturer
Prestige of retailer from whom you bought the product
Design of product (styling, finish, functionality, engineering)
Quality of product
Service of the retailer
Price of the product
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| 8. How did you become acquainted with Broyhill? (check all that apply) |
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| 9. Have you ever purchased any Broyhill furniture? Was it a joint purchase? |
Yes
No
Unsure
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| 10. What are the most important features that would prompt you to purchase Broyhill product? |
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| 11. Would you suggest any improvements to Broyhill furniture? |
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| 12. Do you currently have a need to purchase furniture? If so what is the reason? |
Recent move
Remodeling/addition to home
Redecoration
Furniture Replacement
Desire for new furniture
Second home
Marriage
Divorce
Other
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| 13. When was your last furniture purchase? |
Within last 6 months
Within last year
Within last 2 years
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| 14. How long have you lived at your current residence? |
Less than 1 year
1 - 5 years
5 - 10 years
Over 10 years
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| 15. How likely are you to purchase products by Broyhill? |
Very likely
Somewhat likely
No opinion
Somewhat unlikely
Very unlikely
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| 16. How likely are you to recommend Broyhill to others? |
Very likely
Somewhat likely
No opinion
Somewhat unlikely
Very unlikely
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| 17. May we add your name to our Customer Response Panel? Periodically we request input from members of this panel. Sometimes you could receive compensation for your participation. |
Yes
No
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Broyhill respects and is committed to protecting your privacy. Your personal information will only be used to provide you with information concerning our products. Your information will never be sold to other entities. Broyhill will take all reasonable precautions to prevent the misuse of any of your information. Please click here for more information. |
