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Media Survey Form

MEDIA SURVEY

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____________________________________________