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If you wish to become an agent, please fill in the online enquiry form provided below. You MUST read the terms and conditions before submitting the form. We deal with you guys in a slightly different way to some other research agencies. We don't do impersonal bulk emails asking you to do a visit to a mobility aid retailer even if we know that you are 21 and in robust health. We talk to you on the phone and ascertain personally if you are suitable for a particular assignment. We will send you a complete briefing pack and details of your "handler" within our offices whom you can contact any time with any queries you might have.

 

Christian or Given Name:
Last Name:
Daytime Telephone Number:
Mobile Telephone Number:
Email Address:
House Number/Name and Street:
Area/Village
Town:
County:
Postcode:
Date of Birth
Your occupation (leave blank if not applicable):
Do you have any disabilities?
Ethnic Background:
Languages Spoken: English
French
Spanish
German
Italian
Eastern European
Urdu
Hindi
Sylheti
Mandarin
Cantonese
Other
Please state whether you are: A homeowner
Living with parents
A tenant
House sharing/Flat mate
Do you own a car?
Please state the distance you are willing to travel by car or public transport 1-5 miles
5-10 miles
10-15 miles
15-20 miles
Over 20 miles
From time to time our clients require agents to make a purchase. Would you be prepared to do so in advance of being reimbuirsed? Yes
No
Maybe, depends on how much I'd have to spend
Please state your religion if any:
Hobbies and Interests Sports (Playing/watching)
DIY
Cooking
Music
Theatre
Pub
Travel/Tourism
Reading
Computer
Television/Film
Alternative Therapies
Outdoor Activities
Photography
Arts and Crafts
Are you male or female?
Please check the appropriate boxes for what best describes you. Dark Hair
Fair Hair
Long Hair
Short Hair
Clean Shaven
Facial Hair
Glasses Worn
Average Height
Short
Tall
Average Build
Slim / Athletic
Larger Build
Smoker
Non-smoker
Casual Dresser
Smart Dresser
How much would you spend on an average night out?
Do you have video mystery shopping experience? Yes, I have my own equipment
Yes, I don't have my own equipment
No, but I'd like to give it a go
No, I'm not interested in doing video
How did you find out about Impact MSL? Recommended by friend or family
Web search
Through a forum notification
Through ecademy
Through another advertisement
Other
Please check here to demonstrate that you have read the terms and conditions    Yes

 
 
 

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