NATIONAL AUTO STUDY

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* 1. Address

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 2. Into which of the following age groups do you fall?

20's

30's

40's

50's

60's

70's

80 +

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* 3. What is your exact age?

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* 4. What is your gender?

Female

Male

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* 5. What is your Ethnicity?

African American

Caucasian

Hispanic

Asian

Native American

Pacific Islander

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* 6. Which of these best describes your marital status and household situation?

Single, never married

Married or living with a partner

Widowed, divorced, or separated

Living with roommates

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* 7. What is the total annual income of your household before tax and other deductions?

below 30000 $

30.000 $ - 49.999 $

50.000 $ - 69.999 $

70.000 $ - 99.999 $

100.000 $ - 119.999 $

120.000 $ - 139.999 $

140.000 $ - 159.999 $

160.000 $ - 179.999 $

180.000 $ - 199.999 $

200.000 $ - 249.999 $

250.000 $ - 299.999 $

300.000 $ - 349.999 $

350.000 $ - 399.999 $

400.000 $ and more

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* 8. What is the make of your vehicles?

Audi

BMW

Ford

Honda

Infiniti

Jaguar

Land Rover

Lexus

Mercedes-Benz

Porsche

Tesla

Toyota

Other (please specify)

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* 9. Please enter the make, model, and year of your vehicles.

VEHICLE 1

VEHICLE 2

VEHICLE 3

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* 10. Did you purchase or lease your vehicle?

Purchase

Lease