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Daytipper Demographic Survey
1. Are you:
Male		Female
2. What is your age?
18-24		25-34
35-44		45-54
55-64		65 or over
3. What is the highest level of formal education you have completed? (Please check only one.)
Attended High School		Graduated High School
Attended College		Graduated College
Post-Graduate Study Without Degree		Post-Graduate Degree
4. What is your marital status?
Married		Single, Never Married
Separated or Divorced		Widowed
5. How many children under the age of 18 live in your household?
Number of Children
6. What is your total annual personal income? (Include income from all sources— salary, bonuses, investment income, rents, royalties, etc. Please check only one.)
Less than $30,000		$30,000 - $39,999
$40,000 - $49,999		$50,000 - $59,999
$60,000 - $74,999		$75,000 - $99,999
$100,000 - $149,999		$150,000 - $249,999
$250,000 - $499,999		$500,000 - $999,999
$1 million or more
7. In which state and ZIP code area is your main residence?
State
Zip code
8. What is your total annual household income? (Include income for all family members and include all sources—salary, bonuses, investment income, rents, royalties, etc. Please check only one.)
Less than $30,000		$30,000 - $39,999
$40,000 - $49,999		$50,000 - $59,999
$60,000 - $74,999		$75,000 - $99,999
$100,000 - $149,999		$150,000 - $249,999
$250,000 - $499,999		$500,000 - $999,999
$1 million or more
9a. Do you own a home, condominium or co-op as your primary residence?
Yes		No
9b. If “Yes,” what is the present market value of your primary residence?
Under $100,000		$100,000 - $199,999
$200,000 - $299,999		$300,000 - $499,999
$500,000 - $749,999		$750,000 - $999,999
$1 million - $1.9 million		$2 million or more
If $2 million or more, please estimate value
10. Do you own a second home, condominium or co-op?
Yes		No
11. What is the total net worth of yourself and all members of your household? Include the estimated market value of your business if you own one, all real estate, including primary residence, car, household possessions, bank accounts, stocks, bonds and other investments and assets.
Less than $50,000		$50,000-$99,999
$100,000-$249,999		$250,000-$499,999
$500,000-$749,999		$750,000-$999,999
$1 million - $1.4 million		$1.5 million - $1.9 million
$2 million - $4.9 million		$5 million - $9.9 million
$10 million and over
OPTIONAL: Please provide your contact information if you want to be eligible for our monthly merchandise drawing. Each month one randomly selected recipient will receive a free Daytipper T-shirt.
Name
Address Line 1
Address Line 2
City
State or Province
Zip/Postal Code
Country
Shirt Size		Small
		Medium
		Large
		X-Large

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