Please fill out the survey below completely (all 19 questions) to be eligible for the free promotional offer. OFFER VALID WHILE SUPPLIES LAST. LIMIT ONE PER HOUSEHOLD. U.S Residents ONLY. (* Required Field)
*First Name:
*Last Name:
*Address:
Address2:
*City:
*State:
*ZIP:
  Phone: () - (Area Code)(Phone Number)
*Email:


  If you were referred to this website from a magazine or flyer,
  please enter the 4 digit telephone extension found on the ad:  


1. Your Gender:




2.Marital Status?




3.How many children under 16 are living in your household?




4.Your Age?




5.What is your occupation?

   If other:


6.What is the combined gross income of your household?




7.Where do you shop for health food products?




8.On average, how much do you spend on health food products per month?




9.What do you look for when selecting a multi-vitamin?
To select multiple choices, hold the Control key down and select.

   If other:


10.What should a multi-vitamin do for you?

   If other:


11.Which brand of multi-vitamin are you currently taking?

   If other:


12.What do you think of when you hear the words, "Source of Life"?




13.Which Source of Life product(s) are you currently taking?
To select multiple choices, hold the Control key down and select.




14.How long have you been taking Source of Life?

15.Please rank the following reasons why you are taking Source of Life?
(1=most important, 6=least important & 0=not applicable)

For energy and increased vitality
To make sure I am getting all the nutrients I need because my diet may be lacking something
I want to be healthier and/or feel better
The person who recommended it to me is knowledgeable
It has whole food concentrates and important phytonutrients
Other:



16.If you are taking Source of Life, how were you first introduced to it?



If Other:


17.What would influence you the most to buy Source of Life for the first time?




18.Would you purchase a Source of Life product that you have never purchased before, if you had a money saving coupon?

Yes No


19.Would you purchase a Source of Life product that you have never purchased before, if you could try a free sample?

Yes No







Source of Life taps nature's goodness to unleash its now-famous "Guaranteed Burst of Energy" and its ability to achieve that trademark "Nutritional Feeling of Well-Being".
Source of Life...
the Brilliance
Within You.