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First Name Middle Name
Last Name
Street Address
Apt# City
State Zip Code
Telephone# E-Mail
Date of Purchase Serial No.
Model# Purchase Price
Purchase Locations(store name)
 
* Privacy Policy - We do NOT sell customer information.
* We appreciate your taking the time to fill out this questionnaire. We want to please you, our customer!
 
1. Please add me to the Hearthware Mailing List.
Yes No
 
2. Who was the Primary Purchaser?
a) Male Female
b) Single Married
# of Household members_______
c) Age 20-29 30-39 40-49 50-59 60-69 Over 70
 
3. How did you hear about this item?
a) Retail Store Display e) Catalogue/Magazine
b) Infomercial/TV f) Internet
c) Newspaper g) Other:
d) Friends/Family  
 
4. What is your favorite type of bean?
a) African e) India / Indonesian
b) Central America f) South America
c) Ethiopian g) Not Sure
d) Hawaiian h) Other:
 
5. How long have you been roasting?
a) 0-6 months e) 7-10 years
b) 6-12 months f) 10-15 years
c) 1-3 years g) Over 15 years
d) 4-7 years h) Other:
 
6. Have you purchased other roasters in the past? If so, which one?
a) Precision e) Caffe Rosto
b) Gourmet f) Zach & Dani's
c) Freshroast g) Alpenroast
d) Hot Top h) Other:
 
7. How much coffee do you drink on a weekly basis?
a) 0-3 cups e) 12-14 cups
b) 4-7 cups f) Over 14 cups
c) 8-10 cups g) Other:
d) 10-12 cups  
 
8. Where do you shop most often for electrical household goods?
a) Department Store e) Specialty Stores
b) Internet f) Catalogue / Mail Order
c) Price Clubs g) Infomercial / TV Spots
d) Discount Dept. Stores h) Other:
 
9. Occupation?
a) Management f) Homemaker
b) Secretarial g) Professional
c) Sales / Marketing h) Academic
c) Customer Service i) Retired
e) Self-Employed j) Other:
 
10. Would you recommend the I-roast to your family or friends?
Yes No