Fill out our consumer survey, and you will be entered into a drawing to win dinner for two at one of Birmingham's premier restaurants.  Winners will be notified by email.  No purchase necessary.
The Value Pages Consumer Survey:
Gender
Male   > Female
Age Range
18 - 24
35 - 44
55 - 64		   25 - 34
45 - 54
65+
How often do you use coupons?
Once a month
2-5 times a month
5-9 times a month 		  10+ times a month
Never
How often do you dine out?
Once a month
2 - 5 times a month
5 - 9 times a month
10+ times a month		  
What is your household income range?
$25,000 - $34,999
$35,000 - $44,999
$50,000 - $74,999
$75,000 - $99,999		   $100,000 - $124,999
$125,000 - $149,999
$150,000 - $199,999
$200,000+
Are you a homeowner or a renter?
Homeowner   Renter
What is your home value range?
$100,000 - $149,999
$150,000 - $199,999
$200,000 - $249,999
$250,000 - $299,999		   $300,000 - $349,999
$350,000 - $399,999
$400,000 - $449,999
$450,000+
How often do you use the internet?
Once a month
2 - 5 times a month
5 - 9 times a month
10+ times a month		 
Personal Information:

Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Home Phone
E-mail
 
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