Spending Survey 2016

THIS IS AN ANONYMOUS SURVEY TO DETERMINE OUR COLLECTIVE PURCHASING POWER – Please DO NOT include your name or any personal information. We want to approach businesses for support and donations, based on where our members spend their $$$’s and we want to be armed with this vital information.

The businesses you frequent and the amount you spend are important in our pursuit of their support. If you purchased in multiple categories at one store (like Target, Walmart, etc.,) just list it all in one place – no need to break it up. Most important is, as a group, how much we’re spending and where we’re spending it. Our collective dollars empower us. Please complete the following for all purchases (your best estimate) for the period November 10 - December 10, 2016.

1. Where do you buy Grocery/Pharmacies (Including household products):

Space Cell	Business Name	Location	Amount Spent in $
1	1: Business Name	1: Location	1: Amount Spent in $
2	2: Business Name	2: Location	2: Amount Spent in $
3	3: Business Name	3: Location	3: Amount Spent in $

2. Where do you buy Gasoline:

Space Cell	Business Name	Location	Amount Spent in $
1	1: Business Name	1: Location	1: Amount Spent in $
2	2: Business Name	2: Location	2: Amount Spent in $
3	3: Business Name	3: Location	3: Amount Spent in $

3. Where do you buy Clothing/Shoes:

Space Cell	Business Name	Location	Amount Spent in $
1	1: Business Name	1: Location	1: Amount Spent in $
2	2: Business Name	2: Location	2: Amount Spent in $
3	3: Business Name	3: Location	3: Amount Spent in $

4. Utilities (electric, gas, telephone/cell phone, internet, etc.)

Space Cell	Business Name	Location	Amount Spent in $
1	1: Business Name	1: Location	1: Amount Spent in $
2	2: Business Name	2: Location	2: Amount Spent in $
3	3: Business Name	3: Location	3: Amount Spent in $

5. Appliances & Electronics (TV’s, DVD’s, Large/Small Appliances, Electronic Devices)

Space Cell	Business Name	Location	Amount Spent in $
1	1: Business Name	1: Location	1: Amount Spent in $
2	2: Business Name	2: Location	2: Amount Spent in $
3	3: Business Name	3: Location	3: Amount Spent in $

6. Fast Food & Restaurants:

Space Cell	Business Name	Location	Amount Spent in $
1	1: Business Name	1: Location	1: Amount Spent in $
2	2: Business Name	2: Location	2: Amount Spent in $
3	3: Business Name	3: Location	3: Amount Spent in $

7. Barber/Beauty Care and Supplies:

Space Cell	Business Name	Location	Amount Spent in $
1	1: Business Name	1: Location	1: Amount Spent in $
2	2: Business Name	2: Location	2: Amount Spent in $
3	3: Business Name	3: Location	3: Amount Spent in $

8. Office supplies:

Space Cell	Business Name	Location	Amount Spent in $
1	1: Business Name	1: Location	1: Amount Spent in $
2	2: Business Name	2: Location	2: Amount Spent in $
3	3: Business Name	3: Location	3: Amount Spent in $

9. Vehicle Expenses (Maintenance/Repair – including vehicle cleaning)

Space Cell	Business Name	Location	Amount Spent in $
1	1: Business Name	1: Location	1: Amount Spent in $
2	2: Business Name	2: Location	2: Amount Spent in $
3	3: Business Name	3: Location	3: Amount Spent in $

10. Other businesses where you spent money during this time: (Can be any of the categories above or other)

Space Cell	Business Name	Location	Amount Spent in $
1	1: Business Name	1: Location	1: Amount Spent in $
2	2: Business Name	2: Location	2: Amount Spent in $
3	3: Business Name	3: Location	3: Amount Spent in $
4	4: Business Name	4: Location	4: Amount Spent in $