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Door Knock Address

Address

City

Affiliated with

No worries, we just want to know if you personally think the air out here has gotten BETTER, WORSE or STAYED THE SAME since you've been out here?

GO TO NEXT PAGE

HI THERE!

JUST OUT HERE

DOING A QUICK

4 QUESTION SURVEY

ON THE AIR QUALITY

ONE

SINCE YOU'VE OWNED YOUR HOME HERE WOULD YOU SAY THE AIR HAS GOTTEN BETTER, WORSE OR STAYED THE SAME?

RENT HOME

BETTER

WORSE

SAME

TWO

DO YOU BELIEVE THE AIR IS BETTER INDOORS, OUTDOORS, OR THE SAME?

INDOORS

OUTDOORS

SAME

THREE

HOW ABOUT WHERE YOU WORK? WOULD YOU SAY THE AIR IS BETTER, WORSE OR THE SAME AS HOME?.

BETTER

WORSE

SAME

NOT INTERESTED IN SURVEY

FOUR

OK, LAST QUESTION, ANYONE IN YOUR HOME HAVE ANY ALLERGIES, ASTHMA OR BREATHING PROBLEMS?

YES

I'M SORRY TO HEAR THAT... IS IS JUST YOU? OR YOUR SPOUSE AND KIDS TOO? *

JUST ME

SPOUSE

CHILD

SOMEONE LIVING THERE

OH GOOD! YOU'RE BLESSED! YOUR SPOUSE OR KIDS DON'T EITHER? *

NO SPOUSE

YES SPOUSE

KIDS

OTHERS LIVING IN HOME

Well thanks for helping us out, not everyone is willing to so we genuinely appreciate it.

HAND THEM CARD

Just for answering puts you in a drawing for a free clean air machine.

It uses water and mineral oils to sanitize, fragrance and ionize your air.

My name is ________, and can I get your name for helping us out?

First Name

Ok and what's a good number to reach you at if you are drawn? We ONLY call if you're drawn and won't bug you for any other reason

Phone Number

ENTER DRAWING

I DON'T GIVE OUT MY NUMBER

EMAIL ONLY

PASS

I UNDERSTAND, WE ONLY CONTACT YOU IF YOU ARE DRAWN.

OUR OFFICE IS ACTUALLY LOCAL AT THE ADDRESS THERE ON THE CARD AND WE ARE THE ONLY ONES WHO GET THAT INFO.

WE DON'T SELL IT OR GIVE IT AWAY AND IF YOU'RE NOT DRAWN, WE PROPERLY DISPOSE OF THE CARD, SOUND FAIR?

TAP NEXT TO GO BACK TO LAST PAGE

Email *

INSTANT WINNER!

Date Set For (Live Door Knock)

Time Requested? (Live Door Knock)

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Comments

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This is only for practice, no information is saved, submitting will delete & start a new blank survey

HAPPY TRAINING!