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Product Evaluator Request

Kyocera Wireless Corp. is looking for participants to test our exciting and innovative consumer products. To apply, please complete the following online survey.

Testing with Kyocera Wireless Corp. is voluntary, and all information is strictly confidential.

Please complete the fields in the form below. Fields indicated with an asterisk * must be completed.

* First Name
 Middle Initial
* Last Name
* Home Address
 Apt #
* City
* State
* Zip
 * Home Phone

Please do not use hyphens, periods, or parentheses.

* Work Phone

Please do not use hyphens, periods, or parentheses.

* Work Zip Code
* Email

Please enter only one email address.

Please provide the following information
If employed outside the home, please state your company's name.
Company Name:
Have you ever tested a Kyocera Wireless Corp. product? 		* Do you or does anyone in your household work for a...
Yes No If yes, give approximate date:  / 
MO YR
Demographic Information
* Gender
Male Female
* Age
Do you have a cellular phone?
Yes
Brand:
Model:
No (If no, please skip to the last question.)
How long have you owned your current cellular phone?
What Cellular or PCS service provider do you currently use?
Please provide information on the use of your cellular phone
Primarily what do you use your cellular phone for?
Estimate your usage of your current cellular phone for the following
Number of Minutes used in Voice Calls Per Month
Number of Text Messages Sent Per Month
Number of Minutes used Web Browsing on Cellular Phone Per Month
Number of Minutes used Downloading Applications and Ringers on Cellular Phone Per Month
Please answer the following questions
How did you hear about our test program?
If you know of anyone who may be interested in participating in this or future test cycles, please list the following:
Name:
Email Address:
Phone Number:
CLEAR