| HOME | REGISTRATION FORM | FREQUENTLY ASKED QUESTIONS |
DETAILS:
Compulsory fields: **
At least one input required: **
First Name:**
Surname:**
Phone (Home):**
eg: 9754 0000
Phone (Work):**
Phone (Mobile):**
Suburb:**
State:**
Postcode:**
Email Address:**
How often do you check your Email?**
DOB:**
DOB Spouse/Partner:
Gender:**
Marital Status:
EMPLOYMENT:
Job Title / Occupation:
Employment Status:
Employment Location:
Self Employed: No: Yes:
Partners Occupation:
MISCELLANEOUS:
Do you have children?**
No: Yes:
If yes, how many?
Do you have pay tv?**
No: Yes: If yes, which one?
Do you have any pets?**
No: Yes: If yes, what type?
Are you a smoker?** No: Yes:
Do you have private health care?**
No: Yes: If yes, with who?
Living Arrangements:**
Do you drink alcohol?**
No: Yes: If yes, which ones? Beer Wine Spirits
Country of Birth?**
Car-1: Car-1 Make: Car-1 Model:
Car-2: Car-2 Make: Car-2 Model:
Do you have a computer at home?** No: Yes:
INSURANCE:
Home & Contents:**
No: Yes: If yes, with who?
Car Insurance:**
No: Yes: If yes, with who?
FINANCE:
What bank do you have your main
account with?**
What type of accounts do you have?** Savings
Cheque
Credit Card
Investment
AVAILABILITY:
When can you attend a focus group?** Day Evening Weekends
Where are you prepared to travel?** City Parramatta Hurstville Lower North Shore
ABOUT US:
How did you hear about us?**

MCCOY RECRUITMENT PH: 0414 401 313 mccoy_recruitment@yahoo.com.au ABN: 945 640 709 68