shopper application:
please fill out the form below...
general information:
First Name:
Last Name:
Street Address:
City:
State:	select a state Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip:
Home Phone: please use the format 555-555-5555
Work Phone: please use the format 555-555-5555
Fax: please use the format 555-555-5555
Cellular Phone: please use the format 555-555-5555
Pager/Other: please use the format 555-555-5555
E-mail address:
On occasion we share shoppers with other recruiters who may have a need for shoppers in a specific area. May we share the above information with other recruiters? Yes/No	yes no
additional information:
Age range:	18-25 26-35 36-45 46-55 56-65 66-75 over 75
Number of dependent Children:
Children's ages:
Number of Pets:
Interests/Hobbies:
how may times per month do you eat out at fast food restaurants?
how may times per month do you eat out at family style restaurants?
how may times per month do you eat out at upscale restaurants?
how may times per month do you eat out at other restaurants?
When not mystery shopping, where do you typically do your shopping? (hold the "Ctrl" key down and click to pick multiple answers)	Mart Stores Discount Stores Malls Dept. Stores Boutique Stores Other