Name and Surname *

First

Last

Gender *

Physical Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Age *

Married or Single

Do you shop online?

If yes, how often?

What is the maximum you would spend online?

When purchasing online or instore do you have to consult your partner based on what you spend?

Before ordering online would you go into a store to view the item? *

Is free delivery important to you if you spend more than R5K online? *

Do you research and compare prices of items before purchase? *

If yes, is this instore or online? *

Do you make use of public transport? *

Do you own your own vehicle? *

Who do you bank with? *

If other, please specify. *