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First Name
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Last Name
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Address 1
Address 2
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Phone
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Purchase Information
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Product/Software Title Purchase
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PC ID (4-digits)
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Store Name
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Date of Purchase
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Purchase Decision
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Please check the most important reasons influencing your purchase of this product:
Brand Reputation
Advertised Special
Product on Sale
Salesperson's Recommendation
Friend/Relative's Recommendation
Packaging
Received as a Gift
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How did you first learn about this product?
Word of Mouth
Store Advertisement
Store Display
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Other
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Do you own any bead design programs?
About You
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Your gender
Male
Female
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Education:
High School
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Associates Degree
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Post-Doctoral Studies
Professional Certification
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Do you own a Mirrix Loom?
Yes
No
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Do you design patterns for resale?
Yes
No
Not Yet
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I also do these hobbies in my spare time:
Beading
Blogging
Card Making
Cross Stitch
Mosaic Tile Art
Digital Photography
Rubber Stamping
Scrapbooking
Video Editing
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