Respondents - Lucas Research

How did you hear about us?*

(If Other, please explain)

Name*

First Last

Address 1*

Address 2

City*

Zip Code*

County*

(If Other, please explain)

Primary Phone*

Mobile or Landline?

Birth Date (MM/DD/YYYY)

Email*

Gender*

Male
Female

Please indicate your Race/Ethnic Origin*

Type of residence*

Total Household Income*

Employment Status*

Marital Status*

Occupation*

Industry

Education*

During elections, how do you usually vote?

How many children under the age of 18 living in your household

Do you consume any of these types of alcohol beverages?*

Beer
Wine
Spirits
None of these

Do you own a smartphone*

Yes
No

What type of phone is it?

Primary grocery store*

What is your smoking status*

Never
Current
Former

Do you use an e-cigarette?*

Yes
No

Do you own a cat?*

Yes
No

What brand of kitty litter do you use most often?*

What brand of cat food do you use most often?*

Do you own a dog?*

Yes
No

What brand of dog food do you use most often?*

What types of devices do you use to access television programs?*

Antenna
Cable / Satellite
Playstation Vue
Xbox
Roku
Chromecast
Apple TV
Amazon Fire TV
Other

What types of TV Streaming programming services do you use?*

Amazon Prime - Streaming
SlingTV - Streaming
Youtube / Youtube TV - Streaming
Playstation Vue
Netflix - Streaming
Disney+ Streaming
Xbox
Hulu - Streaming
FuboTV

What types of programs do you watch?*

How many hours per week do you watch TV?*

Do you play games of chance?*

Yes
No

What games of chance do you play?*

Lottery
Scratch offs
Casino
Online Games
Publishers Clearing House & Similar Sweepstakes
Not applicable

Date

Name

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