First Name: Last Name: Street Address:
City: State

Zip:
Email Address: Phone: Cell Phone

Gender: Household Income: Marital Status:
Male Female
Single Married Divorced
Number of kids Occupation Separated Widow
 
How would you describe your style?
Preppy
Fashionable
Classic
Individual Style
Style? What's that?

How important do you think clothing is?
Very important
Somewhat important
Not important
How would you describe your build?
Extra Small
Small
Medium
Large
Extra Large
Other
When shopping for apparel, do you look for any of the following specialty sizes?
Petite
Big & Tall
Plus Size
None of the Above
What is your dress size?
What is your suit size?
What is your shoe size?
What is your shoe preference?
Heels Athletic Shoes    
Flats no shoes    
Flip flops        
           
Do the actors' clothes on the television affect what you buy or wear?
A lot
A little
You only buy what you see on television
If you have a choice between a brand name article of clothing, and one that
is less expensive but not a brand name, which one would you buy?
The brand name clothing
The less expensive clothing
Where do you shop?
Retail
Catalog
Online
When deciding to purchase an item, which one
of the following factors is most important to you?
Price
Quality
Selection
Service
Brand
Style
Convenience
Uniqueness
Thank you for your time. The information you provided will help us bring you only targeted
offers that will save you time in your busy schedule.

Unless I have checked any of the boxes below, Take 5 Solutions, LLC will assume that I do not mind receiving online, postal or SMS offers:
  
I would prefer not to receive online offers, product information,
specials, updates from third party advertisers
 
I would prefer not to receive postal offers, product information,
specials, updates from third party advertisers