Lowes $20 Gift Card Survey

*All Fields are Required. Limit one card per household.

Are you a home owner
 Yes No

How Many People Live In Your Home?:

Ages of Your Home Occupants:
(Check All That Apply)
 0-10 11-20 21-35 36-50 51-60 60-70 Over 70

Does Your Home Have the Following:
(Check All That Apply)
 Garden Pool Air Purifier Water Softener Garage

What Part of Your Home would you Most Like to Improve?

Contact Information:

Your Name

Phone:

Best Time to Contact You:

Street Address:

City:

State:

Zip:

Your Email