Get Paid For Your Opinions

For a company to sell its product or service, it must know what is important to you, the consumer. Market research is the study of consumer behavior.

So, every day these companies pay people like you to participate in surveys, group discussion panels, product testing, etc, in order to gain your feedback. This feedback is vital to their research on how they can improve their products, services, advertising, and overall performance.

Typically, these discussions pay from $50 to $150 for one to two hours, depending on the topic, qualifications, etc. When you sign up, your information goes into our secure database. When we begin a new survey, we contact you via telephone or email to request your participation. Then, you will go through a very brief screening process in order to find out if you are one of the consumers our client is looking for. After qualifying, you will be given a location, date and time for the survey. All you have to do is show up!

Please be aware that because we contact people via phone or email, you should provide us with both if you want the best chance of being contacted. Also, while most of this information is not required, the more information you give us the greater your chances of being contacted are.

We recommend you read our Frequently Asked Questions and our Privacy Statement before filling out this form.

Basic Info

*First Name *Last Name

*Birthdate

*Sex
Male Female

Street Address Home Phone ( ) -

Address 2 Work Phone ( ) - xt

City Cell Phone ( ) -

*State/Province Fax ( ) -

*Zip/Postal Code *Email

County

Demographic Info

Primary Ethnicity
Secondary Ethnicity

Religion Sexual Orientation

Education Household Income

Occupation Industry

Company Name Are you a business owner? Yes No

Do you work Investments (not including home)

Do you own or rent your home? Are you a registered voter? Yes No

Political Affiliation Conservative/Liberal

Are you in a Union? Yes No

Consumer Info

How many hours per week do you spend...

On the internet Watching Television

Listening to the radio

Do you or anyone in your household...

Own pets? Have Cable/Satellite TV?

Buy Diet/Health Foods Yes No Drink Wine Yes No

Drink Beer Yes No Drink Liquor Yes No

Smoke Yes No

What brands of beer? What kinds of cigarettes?

Brand 1
Brand 1
Brand 2

Brand 2
Type
Type

Brand 3
Strength
Strength

Size
Size

How may times per week do you eat... How many times per year do you travel...

Fast Food For business

At a restaurant For pleasure

What four radio stations do you listen to most often? What four magazines do you read most often?

List your four favorite hobbies or pastimes: List four organizations you or your family belong to:

Family Info

Marital Status:

Spouse/Partner name: Spouse/Partner birthdate:

Spouse/Partner occupation: Spouse/Parnter industry:

Spouse/Parter phone: ( ) - Spouse/Partner sex: Male Female

Child 1

Child 2

Birthdate: Birthdate:

Sex: Male Female Sex: Male Female

Child 3

Child 4

Birthdate: Birthdate:

Sex: Male Female Sex: Male Female

Medical Info

Please list medical conditions of yourself or members of your household:

Condition

Family Member

Condition

Family Member

Please list any medications you are currently taking:

Other Info

Are you a vegetarian or vegan? Yes No Do you have food allergies? Yes No

Please describe any other dietary restrictions:

Please tell us about your automobile(s):

Car 1

Car 2

Year Year

Make Make

Model Model

Do you own a boat? Yes No Do you own an RV? Yes No

For home repair do you: For auto repair do you:

Who is the primary decision maker in your household for:

Groceries Electronics

Cars Major Appliances

What company or companies do you use for:

Auto Insurance Cell Phone Service

Cable/Satellite Internet Service

Mortgage Banking

One last question. Please tell us how you found us. *

Cypher Research
2365 Haggerty Road
Suite 300
Canton, MI 48188
Phone: 734-397-3400