Please take a moment to fill out the Shopper Application Form. All information is used solely for our own records so that we may find jobs that will best suit you. Your personal information will not be given or sold to any other company.
Please answer all questions below.

If you are already a registered shopper with PAN Research, please DO NOT fill out this application form. This information will be added to our potential shopper database.

Personal Details
Please complete and submit:  
** Name: 
** Full Address: 

** Email
** Home number: 
Work number: 
** Mobile number: 
** Date of Birth (Digits Only): 
** Do you drive and have your own car and/or access to a car? 
Are you able to travel to do assignments during normal  
business hours, (9am to 5pm?)  
How far are you able to travel to conduct evaluations? 
Do you work outside the home? 
** Do you have a P.C. and access to e-mail/Internet AT HOME? 
How did you hear about PAN Research? 
Sample Evaluation
Please complete the following based on a recent customer experience you had
Is your experience:

Visit to a business premises

Telephone query



1. During the first 30 seconds did the store have a generally positive impact on you?
Yes No Not Applicable

2. Taking into account the number of customers in the store/branch were you greeted within an acceptable time?
Yes No Not Applicable

3. Were you greeted politely?
Yes No

Customer service Issues:

4. In relation to your query did the assistant seem positive and eager to help?
Yes No

5. Was your query handled at an acceptable pace, i.e. not rushed?
Yes No

6. Rate the attempt the assistant made to find out what you were interested in;
Very Good Good Average Fairly Poor Poor

7. Rate the assistant's overall sales performance:
Very Good Good Average Fairly Poor Poor

8. Based purely on your experience with this assistant, would you return to this business?
Yes No

Please provide here, Detailed Comments on what happened during the visit or call.

Please comment on Q1 and 2 if you answered 'No'. Please also explain your answers to Q4 to Q7. Please write at least 6 lines of comments describing your experience and opinion of the service you received:

Independent Contractor Agreement

Please indicate that you have read and agreed to the terms of the PAN Research Ltd. Independent Contractor Agreement.

Thank you for filling out the application form. Please check it over before hitting the SUBMIT APPLICATION button below. Click the CLEAR CONTENTS button only if you want to clear the contents of the application.