DIY Legal Forms

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Media Survey Report

Thank you for your support. Please tick the following boxes to enable to serve you better in the future.

How did you learn of our product?

(1) Television Commercial(s)? Yes [ ] No [ ] If "Yes", which channel? (2) [ ] (7) [ ] (9) [ ] (10) [ ] (Other [ ].

When? Morning [ ] Afternoon [ ] Evening [ ] Late Night [ ]

(2) Radio? Yes [ ] No [ ] If "Yes", which station? (Name).

When? Morning [ ] Afternoon [ ] Evening [ ]

(3) Newspaper? Yes [ ] No [ ] If "Yes", which one? _________________

(4) Store Display? Yes [ ] No [ ] If "Yes", which store? ______________________.

(5) Direct Mail? Yes [ ] No [ ]

(6) Mail Order Ad? Yes [ ] No [ ] If "Yes", which publication? _______________.

(7) Other __________________.

(8) Additional comments: