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Monster Media 1993 #2
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FORM.DOC
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1993-06-10
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****** SMALL & HOME BUSINESS JOURNAL ON-DISK -- VOL I NO I ******
=================================================================
COPYRIGHT 1993 PAT FLANAGAN PUBLISHING & DESIGN
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SUBSCRIPTION FORM
Please send this form and a check or money order (no cash please) for $27.95
to: Pat Flanagan Publishing & Design, 540 Imus Dr., Mishawaka, IN 46545.
NAME _______________________________________________________________________
BUSINESS NAME ______________________________________________________________
ADDRESS ____________________________________________________________________
CITY ____________________________________________ STATE _____ ZIP __________
PHONE # ______________________________ FAX # ______________________________
THANK YOU!!!
------------------------------------------------------------------------
SUBSCRIBER SURVEY
This survey is to gather group information about our subscriber base. All
questions are optional and answers will not be connected to your mailing
list entry. Please check the line that applies.
A) GENDER Male ________ Female ________
B) MARITAL STATUS Single ________ Married ________ Divorced ________
C) AGE Under 18 ________ 18-25 ________ 26-45 ________
46-65 ________ 65+ ________
D) HIGHEST EDUCATION Grade School ________ High School ________
College ________ Post-Graduate ________
E) NUMBER OF PEOPLE IN HOUSEHOLD ________
F) HOUSEHOLD YEARLY INCOME $10-20,000 ________ $20-30,000 ________
$30-40,000 ________ $40-50,000 ________ $50-75,000 ________
$75-100,000 ________ $100,000+ ________
G) OFFICE IN HOME? Yes ________ No ________
H) WHAT TYPE OF BUSINESS DO YOU RUN? _____________________________________
I) HOW LONG HAVE YOU BEEN RUNNING YOUR BUSINESS? _________________________
NOTE: From time to time, SHBJ will make available to subscribers products
or services deemed to be of interest or particularly good value. If
you would not like to be included on a mailing list for information
about these products and services, please check this line. __________