Shoppers In Mansfield, TX – Jessica Jenkins & Associates

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Participant Form

Primary Grocery Shoppers In Mansfield, TX

Thank You for your interest in participating in our current Focus Group for Grocery Shoppers in Mansfield! Your thoughts and opinions are valuable, and we hope to be in touch soon! Please fill out this form and, if selected, we’ll be reaching out to you soon to get you enrolled into the Focus Group.

Register with us by filling out the form below.

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Participant Info

First Name^*

Last Name^*

Age^*

City / State^*

ZIP Code^*

Gender

Male
Female

Contact Info

Phone^*

Secondary Phone

Email^*

Demographic Details

Ethnicity^*

Highest Level of Education^*

Current Employment Status^*

Job Title / Employer^*

Annual Household Income^*

Shopping Habits

Are You The Primary Shopper For Groceries In The Household?^*

Yes
No

Which of these stores do you typically shop?^*

Walmart
Kroger
Tom Thumb
Sprouts
Aldi
Market Street
Whole Foods

How Many (If Any) Children Do You Shop On Behalf Of?^*

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