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Name (first, last):

Street Address 1:

Street Address 2:

City:

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Mercedes-Benz Automobiles Currently Owned:
Current Mercedes-Benz Number One:
Year:

Model:

Other Model (if not listed):

Current Mercedes-Benz Number Two:
Year:

Model:

Other Model (if not listed):

Current Mercedes-Benz Number Three:
Year:

Model:

Other Model (if not listed):

Previous Mercedes-Benz Automobiles Owned:
Previous Mercedes-Benz Number One:
Year:

Model:

Other Model (if not listed):

Previous Mercedes-Benz Number Two:
Year:

Model:

Other Model (if not listed):

Previous Mercedes-Benz Number Three:
Year:

Model:

Other Model (if not listed):

Mercedes-Benz Automobiles You Plan on Owning:
Planned Mercedes-Benz Number One:
Year:

Model:

Other Model (if not listed):

Reason(s) why this model is desired by you:

Planned Mercedes-Benz Number Two:
Year:

Model:

Other Model (if not listed):

Reason(s) why this model is desired by you:

Planned Mercedes-Benz Number Three:
Year:

Model:

Other Model (if not listed):

Reason(s) why this model is desired by you:

What was/will be your first decade of Mercedes-Benz Ownership?
20s
30s
40s
50s
60s
70s
80s
90s
00s

Do you do your own maintenance on your Mercedes-Benz?
No
Only when I have to do it!
Sometimes
Most of the time
Always

Do you do your own repairs on your Mercedes-Benz?
No
Only when I have to do it!
Sometimes
Most of the time
Always

How would you describe your Mercedes-Benz and/or general automotive historical knowledge?
None
Light
Medium
Heavy
Extra Heavy

How would you describe your Mercedes-Benz and/or automotive racing knowledge?
None
Light
Medium
Heavy
Extra Heavy

How would you describe your own Mercedes-Benz technical knowledge?
None
Click and Clack
Light Do it Yourselfer
Medium Do it Yourselfer
Heavy Do it Yourselfer
Professional
Professional, with past or present Mercedes-Benz marque-specific experience

How would you describe your own general automotive technical knowledge?
None
Click and Clack
Light Do it Yourselfer
Medium Do it Yourselfer
Heavy Do it Yourselfer
Professional

I frequently provide other individuals with automobile purchase advice or opinions.
Strongly Agree
Agree
Neither Agree Nor Disagree
Disagree
Strongly Disagree

I frequently recommend automobile repair shops to others.
Strongly Agree
Agree
Neither Agree Nor Disagree
Disagree
Strongly Disagree

I frequently recommend automobile parts suppliers to others.
Strongly Agree
Agree
Neither Agree Nor Disagree
Disagree
Strongly Disagree

I frequently provide other individuals with service and repair advice or opinions.
Strongly Agree
Agree
Neither Agree Nor Disagree
Disagree
Strongly Disagree

I frequently ask other individuals about automobile purchase advice or opinions.
Strongly Agree
Agree
Neither Agree Nor Disagree
Disagree
Strongly Disagree

I frequently ask others to recommend automobile repair shops to me.
Strongly Agree
Agree
Neither Agree Nor Disagree
Disagree
Strongly Disagree

I frequently ask others to recommend automobile parts suppliers to me.
Strongly Agree
Agree
Neither Agree Nor Disagree
Disagree
Strongly Disagree

I frequently ask other individuals about service and repair advice or opinions.
Strongly Agree
Agree
Neither Agree Nor Disagree
Disagree
Strongly Disagree

Are you an Mercedes-Benz Club of America (MBCA) member?
Yes  No
If Yes, how long?
Since year:

Are you: Male  Female

In what year were you born?
19

What is your education level?
Some High School
High School Graduate
Some College
College Graduate
Some Graduate School
Graduate Degree

Describe your profession:

Marital Status?
Single  Married

If married, does your spouse share your enthusiasm about Mercedes-Benz vehicles?
Are you kidding?
Never
Very rarely
Only vicariously
She/he drives it occasionally
She/he hands me tools occasionally
She/he maintains it occasionally
She/he polishes the undercarriage weekly!
She/he drives his/her own!

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