Personal Information

• *Full Name:
• *Email:
• *Age:
  18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70
• *Location (City / State):
• *Do You Consider Yourself:
  Brand Influencer Model Advocate Photographer Athlete Musician Vapor Consumer




Social Media Accounts

• Instagram:
• YouTube:
• Facebook Page Or Group:
• Website Or Blog:




Influence

• *Total Followers/Subscribers On Social Media:
  1-5000 5000-10,000 10,000-50,000 50,000-100,000 100,000-500,000 500,000-1 Million 1 Million Or More
• *Average Comments Per Social Media Picture:
  1-50 50-100 100-500 500-1000 1000-5000 5000-10,000 10,000 Or More




Support

• *How Often Do You Purchase From Our Website:
  Once A Week Twice A Month Once Per Month Once Per Year I Have Never Purchased From Your Website
• *How Many Posts With Our Products Are On Your Social Media Pages (With Our Website URL):
  1-5 5-10 10-20 20-50 50 Or MOre I Have Never Posted Your Products Or Your Website
• *What Is Your Favorite Product You Purchase From Us:
• *Tell Us More About How You've Supported Us In The Past:
• *Tell Us More About How You Can Promote & Support Us In The Future: