1. Do you have a website ?  Yes No
   http:// E-mail

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2. How many affiliates do you have ?  1 1 to 2 3 or more I plan to have soon Nothing
   

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3. Are you planning to join new affiliate programs?  Yes, within the next week Yes, within the next month Yes, within the next 2 to 3 months Yes, between 3 and 6 months Yes, more than 6 months time Yes, don't know when Give me,more option and information
   

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4. If you are planning to have, which state is your first choice for an affiliate ?  Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia 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 Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Canada Mexico Puerto Rico Other Country
   

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5. What type of business do you have ?  Individual Partnership Corporate Family Business Financial Group Real Estate Business Law Business Other
   

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6. How many years in business ?  1-5 5-10 10-20 over 20  
   

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7. How many employees do you have ?  Under 50 51 to 100 101 to 150 151 to 200 201 to 250 251 to 300 Over 300
   

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8. Which type of affiliate business programs are you interested in participating from IndexTan sources
       (Check all that apply)
   

   Banking,Trading	Credit Cards
   Investment	Loans
   Real Estate Services	Business to business
   Network Marketing	Productivity Tools
   Marketing - Office	Employment
   Military	Auction
   E-commerce solutions/providers	Classifieds
   Commercial

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9. Of the following, what types of travel affiliate programs ?
       (Check all that apply)
   

   Personal Insurance	Accessories
   Cruise	Train
   Rental Car	Hotel,Vacation

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10. How did you find our web site?  Search Engine Magazine Newspaper Brochure Word of mouth Web Link Television Radio Other
    

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11. While visiting our web site did you request a special information ?  Yes No No, but I plan on ordering one
    

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12. Would you like to try even more types of affiliate programs ?
        (Check all that apply)
    

    Cosmetics/Fragrance	Handbags	Jewelry
    Shoes	Art	Music
    Photo	Cars & Trucks	Motorcycles - Parts & Accessories
    Tools and Supplies	Rentals	Discount Coupons
    Audio Books - Books - Magazines - News - Television - Videos/Movies	Children Clothing/Apparel	Men Clothing/Apparel
    Women Clothing/Apparel	Malls Clothing/Apparel	Computer & Electronics Computer HW - Computer Support - Computer SW - Consumer Electronics - Peripherals
    Education Children - College - Languages - Professional	Entertainment/ Memorabilia	Family Babies - Children - Entertainment - Teens - Weddings
    Food & Drinks Gourmet - Groceries - Restaurants - Tobacco - Wine & Spirits	Games & Toys Electronic Toys - Games - Toys	Gifts & Flowers Care Packages - Collectibles - Flowers - Gifts - Greeting Cards
    Health & Beauty Bath & Body - Cosmetics - Health Food - Nutritional Supplements - Pharmaceuticals - Self Help - Vision Care - Wellness	Home & Garden Bed & Bath - Construction - Furniture - Garden - Home Appliances - Kitchen - Pets - Real Estate - Utiliti	Insurance Commercial - Personal Insurance
    Legal Services	Medical Equipment	Phonecard Services Online/Wireless
    Recreation & Leisure Astrology - Betting/Gaming - Communities - Events - Matchmaking - New Age - Outdoors - Party Goods	Shops/Malls Virtual Malls	Sports & Fitness Exercise & Health - Professional Sports Organizations - Sports - WaterSports
    Web Services Advice - Banner ads - Domain Registrations - Email Marketing - Internet Service Providers - Intranets - Search Engine - Web Design - Web Hosting/Servers - Web Tools

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13. Why did you visit our Web Site?   To plan a affiliate with IndexTan To decide whether to have a new affiliate To explore,what IndexTan can offer Just browsing the IndexTan
    

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14. How important is our web site's information for making your new affiliate programs ?   Very Important Somewhat Important Not Important
    

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15. Would you like us to email you when we have special offers?  Yes No
    

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16. May we contact you later for a post-affiliate follow up survey?  Yes No
    

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17. If you answered "yes" to Questions 15 and/or 16, please include your email address:
    
    

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18. What is your gender?  Male Female
    

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19. How many affiliate can you handle?  Single A couple More than 3 IndexTan decides based on my website Let me think !
    

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20. How many websites do you own or manage ?  0 1 2 3 4 5 6 7 8 9 10 More than 10
    

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21. Which of the following best describes the highest level of education you have completed?  Grade School Some High School High School Graduate Some College College Graduate Some Graduate School Completed Graduate School
    

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22. Where is your permanent residence?  Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia 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 Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Canada Mexico Puerto Rico Other Country
    

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23. What is your age?  Under 18 18 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65 or over
    

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24. What is your current marital status?  Married Single Separated or Divorced Widowed
    

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25. What is your household or company income?  Under $25,000 $25,000 to $34,999 $35,000 to $44,999 $45,000 to $54,999 $55,000 to $64,999 $65,000 to $74,999 $75,000 to $84,999 $85,000 to $94,999 $95,000 to $104,999 $105,000 to $114,999 $115,000 to $124,999 Over $125,000
    

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26. What is your Zip/Postal code? 
    

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