1. What is your marital status? : --Select Marital Status-- Married Single Divorced/Separated/Widowed

2. How many children do you have? : [None] 1 2 3 4 more

3. Please enter your date of birth (month, day, year).
--Month-- Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec --Day-- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 *

4. What is your gender? :
--Select-- Male Female

5. What is your household's total gross annual income? :
--Select Category-- Under $25,000 $25,001 to $50,000 $50,001 to $75,000 $75,001 to $100,000 over $100,000

7. What are your hobbies/interests? (select all that apply) :
Hold down the "CTRL" key and click to select, or de-select, multiple entries.
arts/crafts automotive board games boating/fishing/diving books business software cooking collectibles (figurines etc.) computer equipment fashion flowers/gift baskets Hollywood/celebrities home decorating investing movies law/criminal justice outdoors (camping, hiking, skiing) productivity software spectator sports sports collectibles travel writing

8. What are 3 web sites do you visit often?
http://
http://
http://

9. What are 3 magazines you've read recently?

10. Where did you hear about tashica?

11. Have you purchased anything on the internet in the past 12 months?
yes  If yes, what did you purchase?
no

12. Have you purchased anything from Tashica?
yes  If yes, what did you purchase?
no

13. Your opinion is important to us. Do you have any comments about tashica?

Yes, I would love to become a "tashica girl" and receive my monthly Fashion Update.