MEDIA SURVEY

How did you learn of our product?
     A. Television Commercial?   Yes_______    No________
           If "Yes", which channel?______________________
           When?    Morning________
                    Afternoon______
                    Evening_______
                    Late Night______
     B.  Radio Spot?       Yes________    No________
           If "Yes", which station?_______________________
           When?    Morning__________
                    Afternoon________
                    Evening________
     C.   Newspaper?        Yes_________    No_______
           If "Yes", which one?____________________________
     D.   Store Display?      Yes_____      No_______
           If "Yes", which store?__________________________
     E.   Other____________________________________________