HOMZ PHONE NAME : wORK PHONE: ADDRESS ZI? CITY: STATE DATE: INTERVIEWER: ORGANIZATION: with Hello on cigarettes and would l1ke Today are conduccing brief survey include your opinions_ household employed eiving_surYeuE; First there vho aryore our 270 tanufacture tobacco products sale or advercising? Zarket researcn Yes TERMINATE nale living betreen che and Is theze hone ages Your least 10 cigarettes per day? shokes 4no Yes TERHINATZ No that person? May speak Yes To CALL MAKZ APPOINIMENT MVESCREENEB LATER TELZPHONE GET NAME AND NUBER _ DATE TIXE 1 601907 CONFIDENTIAL
HOMZ PHONE NAME : wORK PHONE: ADDRESS ZI? CITY: STATE DATE: INTERVIEWER: ORGANIZATION: with Hello Today are conduccing include your opinions_ brief survey on cigarettes and would l1ke First there aryore our household vho employed 270 tanufacture eiving_surYeuE; sale tobacco products Zarket researcn or advercising? Yes TERMINATE Is theze nale living Your hone betreen che ages 4no shokes least 10 cigarettes per day? and Yes No TERHINATZ that person? Yes May speak MAKZ APPOINIMENT To CALL LATER MVESCREENEB GET NAME AND TELZPHONE NUBER _ DATE TIXE 1 601907 CONFIDENTIAL