Form Page 6


The  Purpose of this survey is to collect information on the use of fragranced products, attitudes toward their use, as well as adverse and beneficial aspects of fragrances.

  1. This information is used to determine if there are simularities or differences in age groups, income brackets, gender, etc.
    Age
    Sex Male Female
    Marital Status Single

    Married

    Divorced

    Widowed

    Other

  2. Please indicate if you use the following house hold products, if they are scented or unscented, and how often you use them.
    Laundry Detergent:scented unscented  x daily  x weekly  x monthly other
    Fabric Softener: scented unscented   x daily  x weekly  x monthly other
    Cleaners: scented unscented   x daily  x weekly  x monthly other
    Carpet cleaners: scented unscented   x daily  x weekly  x monthly other
    Air Fresheners scented unscented   x daily  x weekly  x monthly other
    	


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Last revised: February 02, 1999