Media Survey

Media Survey Form

How did you learn of our product?

A. Television Commercial? Yes_______ No________
If "Yes", which channel?______________________
When? Morning________
Afternoon______
Evening_______
Late Night______
B. Radio Spot? Yes________ No________
If "Yes", which station?_______________________
When? Morning__________
Afternoon________
Evening________
C. Newspaper? Yes_________ No_______
If "Yes", which one?____________________________
D. Store Display? Yes_____ No_______
If "Yes", which store?__________________________
E. Other____________________________________________

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