LEAD GENERATOR Time Date Sales Rep Manager Town Name Which Cellphone Network do you use? VODACOM MTN CELL C How do you find the network Good Average Poor May our company contact you via sms to verify i have spoken to you Work Home Marital Status Married Engaged Living Together Single Divorced Widow/Widower Occupation: Husband Occupation: Wife Which number can you be contacted on for future reference. Have you been affected by crime in the last year Yes No Would you rate the effectiveness of the Police as Good Average Poor For safety reasons do you own either of the following Cheque Book Credit Card What type of Credit Card Master Visa Debit Card Cheque Card Other Where do you prefer to shop Pick n Pay Shoprite Checkers Spar Do you consider retail prices to be Over Priced Fair Underpriced What is your combined monthly income before deductions Up to R10 000 R10 500 - R14 500 R15 000 - R18 000 R19 000 - R20 000 R21 000 - R25 000 R30 000+ What is your age Under 30 30-74 74+ How often do you go on Holiday Every two years Once a year Twice a year Do you own any of the following Timeshare PTS Holiday Home Caravan SUBMIT