Mystery Shopper Registration
Form Title
  • 0
  • Name*First & Last Name
    1
  • Email Address*
    2
  • Create Password*
    3
  • Confirm Password*
    4
  • How often do you visit Cinema Cafe?*
    Weekly
    Bi-Weekly
    Monthly
    Bi-Monthly
    Quarterly
    Annually
    5
  • Age Range*
    18-24
    25-34
    35-50
    50+
    6
  • Gender*
    7
  • Household Income*
    8
  • Street Address*### Street
    9
  • Zipcode*
    10
  • Do you own or rent?*select just one
    Own
    Rent
    11
  • How many children in your household?*select just one
    0
    1
    2
    3
    4+
    12
  • Phone Number*xxx-xxx-xxxx
    13
  • Do have a family member or friend that works for Cinema Cafe?*
    Yes
    No
    14