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<TITLE>Willoughby, Dwight & Wright, Inc. - Questionnaire</TITLE>
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<H1>Questionnaire</H1>
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<H3>For us to better serve you, please take a few moments to fill out this questionnaire.</H3>
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Please select your age group:
<INPUT TYPE="radio" NAME="agegroup" VALUE="under 20">Under 20
<INPUT TYPE="radio" NAME="agegroup" VALUE="20-29">20-29
<INPUT TYPE="radio" NAME="agegroup" VALUE="30-39" CHECKED>30-39
<INPUT TYPE="radio" NAME="agegroup" VALUE="40-49">40-49
<INPUT TYPE="radio" NAME="agegroup" VALUE="50-59">50-59
<INPUT TYPE="radio" NAME="agegroup" VALUE="60+">60 or Over
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Are you Male or Female?
<INPUT TYPE="radio" NAME="morf" VALUE="Male" CHECKED>Male
<INPUT TYPE="radio" NAME="morf" VALUE="Female">Female
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What is the number of people living in your household?
<INPUT TYPE="text" NAME="household" SIZE=2>
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Please select your yearly income group<BR>
<INPUT TYPE="radio" NAME="income" VALUE="Under 20">Under $20k
<INPUT TYPE="radio" NAME="income" VALUE="20-34">$20k-$34k
<INPUT TYPE="radio" NAME="income" VALUE="35-49">$35k-$49k
<INPUT TYPE="radio" NAME="income" VALUE="50-69">$50k-$69k
<INPUT TYPE="radio" NAME="income" VALUE="70-99">$70k-$99k
<INPUT TYPE="radio" NAME="income" VALUE="100+">$100k or More
<HR>What is the size of your stock portfolio?
<SELECT NAME="portfolio">
<OPTION>Small
<OPTION>Medium
<OPTION>Large
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What types of stocks are you interested in?<BR>
<INPUT TYPE="checkbox" NAME="Penny" VALUE="Yes">Penny
<INPUT TYPE="checkbox" NAME="High-Tech" VALUE="Yes">Technology
<INPUT TYPE="checkbox" NAME="Mfg" VALUE="Yes">Manufacturing
<INPUT TYPE="checkbox" NAME="Retail" VALUE="Yes">Retail
<INPUT TYPE="checkbox" NAME="Service" VALUE="Yes">Service
<INPUT TYPE="checkbox" NAME="BlueChip" VALUE="Yes">Blue-Chip
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What financial/investment magazines do you read?<BR>
<INPUT TYPE="checkbox" NAME="Forbes" VALUE="Yes">Forbes
<INPUT TYPE="checkbox" NAME="Wall-Street" VALUE="Yes">Wall-Street Journal
<INPUT TYPE="checkbox" NAME="Robb" VALUE="Yes">Robb Report
<INPUT TYPE="checkbox" NAME="Kiplinger's" VALUE="Yes">Kiplinger's
<INPUT TYPE="checkbox" NAME="other" VALUE="Yes">Others
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Would you be interested in a Bonds quoting service?
<INPUT TYPE="radio" NAME="bond" VALUE="Yes">Yes
<INPUT TYPE="radio" NAME="bond" VALUE="No">No
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How did you find out about our service?<BR>
<TEXTAREA NAME="finding" ROWS=6 COLS=40>
Type in here</TEXTAREA>
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How do you rate our service?
<INPUT TYPE="radio" NAME="rating" VALUE="Great">Great!
<INPUT TYPE="radio" NAME="rating" VALUE="VeryGood">Very Good
<INPUT TYPE="radio" NAME="rating" VALUE="Good">Good
<INPUT TYPE="radio" NAME="rating" VALUE="Fair">Fair
<INPUT TYPE="radio" NAME="rating" VALUE="Poor">Poor
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Will you return?
<INPUT TYPE="radio" NAME="visit" VALUE="Yes">Yes
<INPUT TYPE="radio" NAME="visit" VALUE="No">No
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Miscellaneous Comments:<BR>
<TEXTAREA NAME="comments" ROWS=6 COLS=40>
Type in here</TEXTAREA>
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<INPUT TYPE="submit" VALUE="Submit">
<INPUT TYPE="reset" VALUE="Clear">
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<I>Copyright 1996, Que Corporation</I>
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