Shopper Application You must fill in all fields in order for the form to submit correctly. First Name: Last Name: Middle Initial: Street Address: Apt/Box/Suite #: City: State or Province: state"> Alabama Alaska American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacificv California Colorado Connecticut Delaware District Of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Alberta British Columbia Manitoba New Brunswick Newfoundland/Labrador Northwest Territories Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Yukon Zip Code: Country: Home Phone: Business Phone: Fax: Email Address: Age: under 18 18-25 26-29 30-39 40-49 50-59 60 or over Gender: Male Female Income: under $15,000 $16,000 - $29,000 $30,000 - $39,000 $40,000 - $49,000 $50,000 - $59,000 $60,000 - $69,000 $70,000 - $79,000 $80,000 - $89,000 $90,000 - $99,000 $100,000 or over Internet Experience: under 6 months 6 months - 1 year 1-2 years 2-3 years 3+ years Education: grammar/middle school high school diploma some college bachelor's degree graduate degree Marital Status: single married divorced other Number of Children in Household: 0 1 2 3 4+ Ages of Children : Type of occupation: executive/senior management professional/managerial technical/engineering administrative/secretarial sales/marketing/advertising customer service/support college/university faculty K-12 faculty college/university student K-12 student writer/journalist homemaker retired currently not employed other Are you a Business Owner? Yes, and it is my primary source of income Yes, and it is a secondary source of income No List 5 major malls within 30 minutes of your home: Mall 1: Mall 2: Mall 3: Mall 4: Mall 5: Please detail your mystery shopping experience: Indicate your availability in the boxes below: DAY 9 - 12 12 -5 5 - 9 Sunday Monday Tuesday Wednesday Thursday Friday Saturday Please note that submitting this form does not automatically include you into Imaginus' database. We will review your inquiry and contact you as necessary to discuss available opportunities. By submitting this application to Imaginus, please note that in the event you are contacted regarding an assignment, you would be working as an independent contractor and not as an employee of Imaginus.
Shopper Application
You must fill in all fields in order for the form to submit correctly.
First Name: Last Name: Middle Initial: Street Address: Apt/Box/Suite #: City: State or Province: state"> Alabama Alaska American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacificv California Colorado Connecticut Delaware District Of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Alberta British Columbia Manitoba New Brunswick Newfoundland/Labrador Northwest Territories Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Yukon Zip Code: Country: Home Phone: Business Phone: Fax: Email Address: Age: under 18 18-25 26-29 30-39 40-49 50-59 60 or over Gender: Male Female Income: under $15,000 $16,000 - $29,000 $30,000 - $39,000 $40,000 - $49,000 $50,000 - $59,000 $60,000 - $69,000 $70,000 - $79,000 $80,000 - $89,000 $90,000 - $99,000 $100,000 or over Internet Experience: under 6 months 6 months - 1 year 1-2 years 2-3 years 3+ years Education: grammar/middle school high school diploma some college bachelor's degree graduate degree Marital Status: single married divorced other Number of Children in Household: 0 1 2 3 4+
Ages of Children : Type of occupation: executive/senior management professional/managerial technical/engineering administrative/secretarial sales/marketing/advertising customer service/support college/university faculty K-12 faculty college/university student K-12 student writer/journalist homemaker retired currently not employed other Are you a Business Owner? Yes, and it is my primary source of income Yes, and it is a secondary source of income No List 5 major malls within 30 minutes of your home: Mall 1: Mall 2: Mall 3: Mall 4: Mall 5: Please detail your mystery shopping experience: Indicate your availability in the boxes below:
9 - 12
12 -5
5 - 9
Please note that submitting this form does not automatically include you into Imaginus' database. We will review your inquiry and contact you as necessary to discuss available opportunities. By submitting this application to Imaginus, please note that in the event you are contacted regarding an assignment, you would be working as an independent contractor and not as an employee of Imaginus.
