Please provide the Mr. Dahm Rating Company with the following information:

Circle One: Male     Female

 Freshman Sophmore Junior  Senior

Are you employed?_______________

What is your salary?_____________per week, month, or  year

How many TV's do you own________    VCR's_____________

Do you use the following services:  Cable TV:________
                                                     Satellite TV:_________
                                                     Video Rental:_________
                                                      Pay-Per View:_________

THANK YOU FOR PATICIPATING IN OUR RESEARCH- ALL INFORMATION IS CONFIDENTIAL