MHNC-1620 National Consumer Finances

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* 1. Murray Hill National is seeking participants for a paid study, please fill out all the information below.

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 2. What age range do you fall into?

Under 18

18-29

30-49

50-65

Older than 65

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* 3. Which of the following best reflects your ethnic background?

Caucasian

Hispanic

African-America

Asian

Indian

Other (please specify)

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* 4. What is your marital status?

Married

Living with significant other

Single

Widowed

Divorced

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* 5. Who in your household is the primary decision maker for such things as insurance, banking and financial services?

My spouse/significant other

My spouse/significant other and I equally

Myself – I am the primary decision maker

Other (please specify)

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* 6. 1. Do you or anyone in your household have any products or services with any of the following companies? (Examples include, but are not limited to, auto insurance, home owners, renters insurance, checking account, or credit cards.)

Bank of America

GEICO

Navy Federal Credit Union

Wells Fargo

USAA

Progressive

State Farm

Nationwide

JP Morgan Chase

All State

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* 7. Which of the following products or services do you or anyone in your household have from any of the companies we just mentioned?

Auto insurance

Property and casualty insurance (such as homeowner’s or renters Insurance)

Life insurance

A bank account (such as a checking or savings account)

Credit card or debit card

An investment account (such CDs, IRA’s, etc,)

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* 8. Have you or your spouse ever been rejected for a loan, credit card or insurance policy by any of the following companies?

Bank of America

GEICO

Navy Federal Credit Union

USAA

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* 9. Have you, your spouse, OR your parent's or spouses parents ever served in the United States Military?

Yes, I have served in the United States Military.

Yes, My spouse has served in the United States Military.

Yes, My parents OR my spouses parents have served in the united States Military.

No, Neither myself, my spouse, nor my parents or spouses parents have served in the United States Military.

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* 10. Would you willing AND have access to participate in a webcam interview?

Yes