Online Mystery Shopper Application

	Shopper Information   Name (Last, First) , Address City State/Province* Choose One $Shopper{'State'} AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VI VT WA WI WV WY AB BC MB NB NL NS NT NU ON PE QC SK YT Zip - Home Phone Fax Cell Phone Work Phone Email Address Cell Phone We use PayPal exclusively to pay our shoppers. Do you have a PayPal Account? DOB (MM/DD/YYYY)   Do you now, or have you ever worked for a mystery shopping company as an employee or owner/manager? (not a shopper) Yes No Days Available to Shop Choose One $Shopper{'DaysAvailable'} Monday-Friday Weekends Any
	Demographics Why we ask- Depending on the types of business we service, we might may need further demographic information from our shoppers to properly match them with their typical customer.
	Marital Status Unknown Married Single Divorced Widowed Number of children under the age of 18: Unknown None One Two Three Four More Than Four Current Living Arrangements: Unknown Apartment Rental Duplex/Condo Rental Single Family House Rental Homeowner Living with friends/relatives How Did You Hear About Us? Choose One Word of Mouth Business Expo CustomerTrend Website Internet Search (i.e. Mystery Shopping) Internet Posting (i.e. Craigslist) None of the Above $Shopper{'Lead'} How Many Years Have You Currently or Previously Lived in Apartments: Unknown None 1 year or less 2 to 5 years 5 to 10 years over 10 years Household Income Bracket: Unknown 0-$30,000 $31,000-$50,000 $51,000-$75,000 $76,000-$100,000 $101,000 and higher Make/Model/Year of Car You Drive: Hobbies/Interests: Automotive       Entertainment Home/Family       Reading Shopping             Sports Travel                Crafts Exercise/Health  Gardening Music Personal finance Computers/Tech Other Languages you are fluent in: English Spanish French Other How long have you been a mystery shopper? Unknown I am new 1 year or less 2 to 5 years 5 to 10 years over 10 years Occupation: Unknown Accounting/Finance Computer Related Consulting Customer Service/Support Education/Training Engineering Executive/Senior Management General Administrative Government/Military Homemaker Legal Manufacturing/Production/Operations Medical Real Estate Restaurants Retail Retired Sales/Marketing/Advertising Self employed/Owner Student Tradesman/Craftsmen Other Which Industries would you like to be assigned to? (Multiple Choices OK) Retail Restaurants Banks Hotels Grocery Stores Car Dealerships/Automotive Services Housing Other MSPA Certification Unknown Silver Gold Certification Number In 5 sentences only, describe your last customer service experience, good or bad:     Education Level Choose One High School/GED Associate Degree Undergraduate Degree Graduate Degree Other   Gender Choose One Male Female   Do you have Military Clearance? I have no Military Clearance Active Duty Military Retirees Reserves National Guard personnel Department of State Officials serving in foreign countries and dependents of the above Spouse of Military Member Other     Would you be interested in conducting video shops for CustomerTrend Inc.? Yes    No Have you performed video shops for any mystery shopping companies? Yes    No If so, please state approximately how many video shops you have conducted and why you would be a suitable video shopper for CustomerTrend Inc..

   

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CustomerTrend Inc. • www.customertrend.com
14460 New Falls of Neuse Road #149-344, Raleigh, NC 27614 USA
Toll Free: 1-(866)-509-9888 Phone: (919)-341-7624 Fax: (919)-341-7629