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  • Fill out the form below and we will contact you if you qualify. The information you provide will be used for screening purposes and to contact you about upcoming studies.Amazon.com will not release any of the personal information collected from you in this form. See our Privacy Policy for more information.
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CONTACT INFORMATION
 
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PERSONAL INFORMATION
 
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Female
Male
 
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Under 18
18-24
25-34
35-44
45-54
55-64
65 or over
 
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Yes
No
 
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Some high school
High school diploma or GED
Some college
College degree
Masters degree
Advanced graduate degree (e.g., Ph.D.)
 
  
 
  
 
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Less than $20,000
$20,001 to $40,000
$40,001 to $65,000
$65,001 to $90,000
$90,001 to 125,000
Over $125,001
Prefer not to answer
 
  
 
 

INTERNET EXPERIENCE
 
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Not a computer user
Beginner
Intermediate
Advanced
Expert
 
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15 years or more
10+ years
7-9 years
4-6 years
1-3 years
Less than one year
 
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More than 10 hours per week
5-10 hours per week
2-4 hours per week
Less than 2 hours per week
 
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Purchased a product online
Completed a questionnaire or form online
Created a web page or website
Customized a web page (for example, My AOL, My Yahoo or My MSN)
Changed the browsers "start-up" or "home" page
Changed cookie preferences
Participated in instant messaging, online chat or other online discussion (excluding email)
Listened to an online radio broadcast or streaming media (video) presentation
Made a phone call online
Used a website to find an address or telephone number
Took a class or bought a book to learn more about the Internet
Downloaded or exchanged music or video files
Posted digital photos or other image files to a website
None of these activities
 
  
Internet Explorer
Firefox
AOL
Safari (Mac)
Other
 
 

ONLINE SHOPPING EXPERIENCE
 
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Several times a week
Once a week
Several times a month
Once a month
A few times a year
Almost never
Never
 
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Yes
No
 
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6 or more times
4-5 times
2-3 times
Once
I have not made any online purchases from Amazon.com in the past 2 years
 
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Yes
No
 
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11 or more times
6-10 times
4-5 times
2-3 times
Once
I have not made any online purchases in the past 2 years
 
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Books
Music
DVDs or VHS Videos
Magazines
Kitchenware
Consumer Electronics (e.g. digital cameras, laptops, MP3 players, etc)
Jewelry or Watches
Health or Beauty Products (e.g. lipstick, perfume, soap, lotion, etc)
Groceries (food, or dry goods)
Sporting Goods
Apparel
Shoes
Software or Computer Hardware (e.g. keyboard, mouse, etc)
Toys
Used Items
Gifts
Other
I have not made any online purchases
 
 

ADDITIONAL INFORMATION
 
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Yes
No
 
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Yes
No
 
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Email invitation
Friend
Online advertisement or listing
Printed or other form of advertisement or listing
Other
 
* indicates required field