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Shopper Application Form

Fill in or Check off as applicable

 

General Information


Title
:
First Name
:
*
Last Name
:
*
Address
:
*
City
:
*
State
:
*
Country
:
*
Postal Code / ZIP
:
*
Home Phone
:
*
Mobile Phone
:
*
Work Phone
:
FAX Number
:
Email address
:
*
Locations
:
*
How did you become familiar with MSI? *
Friends & Family
Internet
Newspaper
Other Shoppers, Name
Facebook
Radio
Magazine
Other
Please list other Mystery Shopping Companies you currently work for :

Shopper Demographics


Gender : *
Male
Female
Date of Birth : *

Ethnicity *
:
If you answered other, please
Identify your ethnicity
:
Upload Photo
:
Hair Color
:
*
Height
:
*
Weight
:
*
Marital Status
:
*
MSPA Certification
:
MSPA Cert ID
:
Education
:
*
I Speak incl. dialect
:
*
I Write
:
*
Employment Status
:
*
Profession
:
*
Monthly household income : *
< Rp. 1.000.000
Rp. 1.000.000 – Rp.2.000.000
Rp. 2.000.000 – Rp.3.500.000
Rp. 3.500.000 – Rp.5.000.000
> Rp.5.000.000
Do You Smoke : *
Yes
No
My Hobbies
:
*
I Have a : *
Camera Cell phone
Digital camera
Fax machine
Laptop
Microphone
PDA / palm Pilot
Regular cell phone
Video Camera
Scanner
Webcam
What sports do you practice ? *
Which hotel do you usually go to when on business trip ? *
Have you ever been traveling aboard, if yes, where ? *
Favourite magazines (name at least 2) ? *
2 or 3 Clothes Brands you usually buy ? *
How much did you spend last month on clothes ? *
2 or 3 Cosmetic Brands you usually buy ? *
How much did you spend last month on cosmetics ? *
2 or 3 shoes Brands you usually buy ? *
How much did you spend last month on shoes ? *
Brand of watches you own (list if several)? *
Favorite Shopping Place
Do you have a several cars ? *
Yes
No
If yes, what kind of car?
:
Have you ever been to a fashion Show? *
Yes
No
How often do you go shopping? *
Every week
More than once a month
Once a month
2 or 3 times a year
Rarely
How often do you dine in fast food restaurant? *
Every week
More than once a month
Once a month
2 or 3 times a year
Rarely
How often do you dine in full service restaurants? *
Every week
More than once a month
Once a month
2 or 3 times a year
Rarely
How often do you shop in department stores? *
Every week
More than once a month
Once a month
2 or 3 times a year
Rarely
How often do you enter a shopping mall? *
Every week
More than once a month
Once a month
2 or 3 times a year
Rarely
Based on your experience, what brand has the best customer service level? *
Do you like to pay attention to details ? *
Yes
No
Do you remember people easily? *
Yes
No
Have you ever been a mystery shopper? *
Yes
No
Would you be interested to participate to other marketing research programs with us (interviews, focus group… ) ? *
Yes
No

Miscellaneous Information


Do you have a major credit card ? *
Yes
No
Credit card types : *
Amex
Master
Visa
Other
Newsgroups/ Forums I belong to : *
Frequency of website / Internet browsing / week *
Do you have access to a computer at home ? *
Yes
No
If yes, what type of internet connection are you using ?
If yes, what internet providers are you using ?
Do you have access to the internet on your cellphone ? *
Yes
No
Do you have access to the internet on your PDA ? *
Yes
No
Are you a vegetarian ? *
Yes
No
My Word Processor is : *
MS Word
Open Office
Corel Office
Other
My internet browser is : *
Internet Explorer 6.0
Opera
Internet Explorer 7.0
Safari
Firefox
Other
Please write a short paragraph describing your best and your worst shopping experience.

 

I have read, accept and agree the terms of the “Mystery Shopper Agreement”

 

 

 

Note:
* - Required
As a Mystery Shopper for Mystery Shopping Indonesia, you are paid on a contract basis. Because of this status, there will not be an official government earning/ income statement issued at tax time. If necessary, it will be your responsibility to notify your local revenue service of any income earned from your work with MSI.

Please read the following:

Mystery Shopping Indonesia (MSI) retains shoppers to assist in the gathering of information regarding levels of customer service, sales skills, and product knowledge.

By signing up to be a mystery shopper with Mystery Shopping Indonesia (a/n. PT. Praxis Management) the Shopper agrees to abide by the following:

  • The Shopper is and will continue to be a self-employed independent contractor and not an employee of MSI. The Shopper is not a partner, employee, joint venture, or affiliate of MSI and does not have the authority to accept orders for, bind or obligate MSI in any way.
  • The Shopper understands and agrees that he/she is not entitled to and will not receive any medical, dental or other such benefits from MSI. The Shopper is responsible for providing his/her own insurance coverage.
  • MSI will not withhold taxes from any fees payable to the Shopper; The Shopper is responsible for payment of any taxes on any fees received for providing services to and for MSI.
  • The Shopper is responsible for the conduct of his/her business and will comply with all applicable laws. MSI will have no liability to any third parties for any claims arising of the Shopper’s assignment of business. The Shopper will indemnify and hold harmless MSI for any such claims.
  • The Shopper will devote full attention to the project, will conduct himself/herself in a professional manner, and will exhibit professional behavior throughout the assignment.
  • MSI will pay the Shopper a fee agreed upon in advance for each project, payable upon satisfactory completion of the Shopper’s assignment and written report. Payment will be mailed the month following completion of the shop report.
  • MSI will reimburse the Shopper for any pre-authorized expenses incurred while performing assignments for MSI.
  • The Shopper will retain all notes, receipts, and/or business cards for a period of 60-days for each assignment completed for MSI.
  • The Shopper agrees to retain only one shopper account per person and per household with MSI.
  • The Shopper agrees to complete his/her own assigned shops. Work cannot be contracted out to others.
  • The Shopper agrees all records, files, reports, and other documents relating to MSI which the Shopper shall use, prepare, or come in contact with during, or as a result of, a shopping assignment, shall remain the sole property of MSI. Upon termination of this agreement, the Shopper shall immediately return to MSI all originals and copies of such materials.
  • In providing services to MSI, the Shopper acknowledges that he/she will have access to and knowledge of information of a confidential nature and agrees that he/she will not disclose to any individual or business entity information concerning MSI methods, trade practices, evaluation results, or any information deemed by MSI to be confidential for purposes of this agreement.
  • The Shopper understands that a Mystery Shopper only reports what occurred at the time they are conducting the report. They do not give opinions on how client’s business should be run or compare one client’s location with another.
  • The Shopper understands that reports must be submitted to MSI the same day they are completed unless otherwise noted.
  • The Shopper understands that he / she is required to conduct the visit on the selected day. If he/she is unable to complete the shop, he/she needs to decline the shop or notify MSI immediately to cancel the shop.
  • The Shopper understands that he/she must be available at anytime via both e-mail and telephone should MSI need to contact them regarding a current or previous agreement.
  • The Shoppers understand that he/she will be held liable if intentionally report incorrect information.
  • MSI shall be entitled to a preliminary injunction restraining the Shopper from a breach or threatened breach, provided however, that nothing herein shall be construed as prohibiting MSI from pursuing any other remedies available for a breach or threatened breach, including recovery of damages from the Shopper.
  • MSI shall keep all Shopper contact and personal information confidential and shall not disclose to any individual or business entity.
  • MSI has the exclusive right to refuse payment to and/or remove any Shopper that does not comply with this agreement.
  • MSI can, at any time, amend this agreement. Shopper is responsible for complying with any amendments to this agreement.