Service Scan Evaluations Ltd
Mystery Shopper Application Form
SECTION 1: PERSONAL DETAILS
National Insurance Number:
Address - House No. / Name and Street:
Do you have access to the Internet, e-mail and a printer?
Are you, or have you in the past, been a Mystery Shopper /
If so, for which companies?
What type of outlets have you visited? (Please name)
What days/times are you available for work?
SECTION 2: MYSTERY SHOPPER / DINER /GUEST PROFILING INFORMATION
No. of children:
Car Owner / Access to a car:
If you do have access to a car, how far would you be willing
to travel for a Mystery Visit (in miles)?
If you visit other towns/cities on a regular basis would it be
practical to carry out a Mystery Visit whilst in these areas?
If so, which other towns / cities do you visit?
Do you eat out on a regular basis?
Which are your favourite restaurants? (Please name)
Do you use hotels on a regular basis?
If so, which facilities do you use (e.g. accommodation,
restaurant, bar or leisure)?
Which hotels do you use on regular basis?
Do you use a gym / health club on a regular basis?
If so, what is the name of the gym / health club you use?
Which supermarkets do you use the most?
Which department stores / retail outlets do you use?
Please return to: Shopper Recruitment, Service Scan, Westminster Buildings, Theatre Square, Nottingham NG1 6LG
Tel: 0115 958 4727 Fax: 0115 988 1329 E-mail: