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Email *
Name (first and last): *
Age: *
Gender *
Phone Number: *
Which of the following best describes your Ethnicity? *
What is your Highest Level of Education? *
Are you currently employed? If so, what is your current job title? *
Which of the Following Best Represents your Household Income? *
What STATE do you live in? *
What CITY do you live in? *
What COUNTY do you live in? *
What type of vehicle do you drive (make and model)? *
What is the model year of the vehicle listed above? *
Did you purchase, lease or were you given your vehicle through work?
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If you purchased your vehicle, did you purchase it NEW or PREVIOUSLY OWNED?
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When do you think you might purchase a new vehicle?
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Which town do you live closest to?
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