Confirmed Consent

Welcome to ConfirmedConsent.com!

We proudly present the site that values YOUR opinions and enhances your internet experience. From groundbreaking information to the hottest new products, we bring you the web's most exclusive online opportunities and info!

Our network bridges the gap between businesses and customers - so you get the very best sent directly to you. And by joining, you help us help you have a more personalized experience online!

But here's the real news:

WE'LL PAY YOU to join! To prove how valuable you are to us, we'll give you a VISA(tm) Gift Card absolutely free. Our registration form will help us identify your interests so we can automatically show only the offers you prefer! Once you sign up, you'll receive a confirmation email right away. Just click on the "confirm" link within 48 hours and you'll receive your reward. No slogging through page after page of "offers" and "surveys". No "pick one of these 12 specials." No spam. No kidding!

Whether you're a parent looking for the best quality products for your children, or a technology guru waiting for the latest electronics - we have something for everyone! The best part is this: these offers are not found anywhere else except here. Media Network's marketing muscle lets us team with cutting edge suppliers to bring you exclusive, insider deals most "regular" people will never see, at savings you'll have to see to believe!

Only 100,000 sharp surfers will have the opportunity to belong to Confirmed Consent, so act now!

When you join this exclusive club, we'll pay you - but that's not all. We'll also guarantee that your valuable personal information stays only with us. You become a member of a very exclusive group of savvy consumers, and we'll treat you like the important decision maker you are. That means you'll NEVER see offers from "partners" or "affiliates." No marketing mumbo-jumbo. No nonsense. Just premium offers, big savings, and exclusive access to the hottest new products and services.

Our entry form will take a few minutes of your time, but spending those few minutes will pay huge dividends. First, of course, you'll get a free Visa(tm) Gift Card as our "thank you" and welcome gift. But as time goes by, you'll thank yourself every day for spending those few minutes.

So please don't waste your time with dozens of ads and solicitations that may or may not be up your alley - join today, and tailor the internet to you!

ConfirmedConsent.com

Personal information
First Name
Last Name
Your Email
Confirm Email
Date of Birth
Gender Male Female
Martial status Single Married

Home address
Address
City
State		ZIP

Mailing address
Copy info from home address
Address
City
State		ZIP
Home phone	Cell phone	Business phone

Household Info
Household income
Profession?
How long?
Highest education? High school Some college College graduate Grad/Professional school Post grad
How many people in your family?
How many children do you have?
Do your children use the internet? Yes No
What kind of computer do you have? Desktop Laptop
Brand name
Do you use parental controls on your childrens computer? Yes No
Would you like to learn more about protecting your children online? Yes No
What kind of phone service do you use? Mobile Landline VOIP
Who do you use for internet service? Local Cable Other (please specify) :
Do you chat using IM services? Yes No
If yes, what service do you use? yahoo AIM MSN google
Are you a member on social networking sites? For example myspace? Yes No
Do you rent/own your home? Rent Own
Do you have a mortgage? Yes, its current No, its paid off I am having trouble keeping up with my payments
Do you own a car? Yes No
What type of car do you own? American Import
Do you own a boat? Yes No
What type of boat do you own?
Do you use public transportation? Yes No
Do you have insurance? Home Vehicle Health Life
What CC's do you own Visa Mastercards AmEx Discover
Do you use your credit cards and/or checks online? Yes No
Do you have a bank account? Savings Checking Other (please specify) :
Does your current bank use online banking? Yes No
Do you pay your bills online? Yes No
Do you shop online? Yes No
If yes, please list the online stores you've previously shopped at
Do you purchase valuables/high ticket items online? Yes No
Do you purchase electronics online? Yes No
Do you order groceries online? Yes No
Do you drink alcoholic beverages? Yes No
Do you smoke tobacco products? Yes No

What are your areas of interest?
Top credit cards debt consolidation free stuff internet business internet shopping it professionals laptops music sales management small business system administration webmasters
Business and Tech advertising affiliate programs business traveler customer relationship management data storage and warehousing entrepreneurs high speed internet access human resources insurance internet marketing internet security investing and finance local area network marketing directors multi-level marketing networking operating systems printers purchasing managers sales automation sales and marketing software deals software designers software internet website design website hosting
Consumer consumer electronics contests and sweepstakes cookbooks free stuff gambling and lotteries magazines mp3 mystery books romance books science fiction books shoppers on the internet sports and recreation toys and games travel and leisure video dvd wireless communication

Personal information

Home address

Mailing address

Household Info

What are your areas of interest?

Consumer Survey

* In order to receive your Visa Gift Card, you must be at least 18 years of age and you must fill in 100% of the registration form. You must also add us, updates@confirmedconsent.com, to your address book. Thanks!

Consumer Survey
Are you interested in online surveys to improve your internet experiences? Yes No
Are you interested in exclusive offers and free giveaways? Yes No
Please provide us with a sample description of the products and/or services you have ordered online in the past year
Are you interested in online subscriptions? Yes No
Would you like to receive promotional material related to your areas of interest? Yes No
Do you download music/videos? Yes No
If yes, please list some recent downloads
Do you have an MP3 player? Yes No
If yes, what kind? iPod SanDisk Sirius Zune
Do you gamble online? Yes No
Do you eat out? Yes No
If yes, what are some of your restaurants of choice?
Do you own a video game console? Yes No
If yes what kind? Sony Nintendo Microsoft
Do you rent movies online? Yes No
Are you interested in the latest technology news? Yes No
Are you interested in the latest electronics? Yes No
Are you interested in the latest retail products? Yes No