Earn Money For Sharing Your Opinions!
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The questionnaire gathers basic information about you and your household. This information enables us to "target" the people most appropriate for a particular study. Each study is unique and requires people who meet certain criteria, such as age, or other specifications, such as the use of a particular product or service. We will contact you periodically to determine if you qualify to be invited to participate in studies we are conducting.
Your contact information is very important. If we can't reach you, we can't invite you! Also, please provide your email address so we can let you know about upcoming studies via the Research Alert from Opinions Unlimited.
We are a Texas-based opinion and survey research company. While we conduct studies nationwide, we only accept Texas residents into our database of Research Panelists.
Note: Some internet service providers, such as AOL, may have difficulty sending information via this format. If you would rather provide this information by telephone, please call 713.358.8316 or 214.265.1034 and leave your name, a convenient time to of day to call and the number where we can reach you.
Required information is marked with an asterisk *

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First Name *

Last Name *
Address *
Apt / Suite #
City *
State
Zip Code *
County
Household Type
E-Mail Address *
Home Phone Number *
Cell Phone Number 
Work Phone Number 
Fax Number 

You have my permission to contact me about current or future research opportunities by phone, fax, email or any other contact information that I have provided *

Gender *



Date of Birth * MM/DD/YYYY / /

Ethnic Information *

How did you hear about us *
Detailed information

Remember, the more information we have the better chance we can fit you into a Focus Group.
Marital Status
Education
Employment Status
Household Income
Job Title
Family Information
Children under age of 18 living at home.


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Vehicle Information
Vehicle 1 Year
Vehicle 2 Year
Recreation Vehicle 1
Recreation Vehicle 2
Dining Information
Dining Information: How many times a week do you eat at . . .
Fast Food Restaurants
Sit Down Restaurants
Miscellaneous Information
Check all that apply.
Do you Smoke
Do you drink Liquor
Do you drink Wine
Do you drink Beer what brands?
Do you play Lotto/Lottery
Are you a Registered Voter
Have computer in Home
Medical Information

Do you have any of the following medical conditions, check all that apply.
Diabetes Type I
Diabetes Type II

HIV
Heart Disease
Hepatitis
Eye Disease
Allergies
Asthma
Pet Information 
What pets do you own, check all that apply.
Fish
Dogs
Cats
Birds
Horse
Other
Music Information

What music do you like to listen to, check all that apply.
Christian
Classical
Contemporary

Country & Western
Rock
Rhythm & Blues
Easy Listening
Gospel
Jazz
Mix

Oldies
Pop
Tejano
Rap
Other
Hobby Information
List Hobbies
   
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When you click on the submit button, a menu will appear. Choose continue to submit your information. An attachment with your information will be placed in an e-mail that you can simply send to us.