Whirlpool Washing Machine Product Tester Submission Form

This is a quick survey to have the chance to test and review new Whirlpool washing machine products, please answer as honestly as possible. Each tester will be required to test a product. The information gathered is needed solely for testing products by Whirlpool. Data collected will be kept private and confidential and will not be passed onto any third parties for marketing purposes.
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Phone Number*

Area CodePhone Number
Gender

MaleFemale
Age Range

18 - 2425 - 3031 - 3536 - 4041 - 4546 - 5051 - 5556 - 6061 - 6565 +
Number of children

01234+
Occupation
Do you currently own a Whirlpool appliance if so please indicate which:

Washing MachineTumble DryerFridge FreezerRefrigeratorFreezerDishwasherCookerOvenHob
What type of kitchen do you own?

Built-inFreestanding
Would you recommend Whirlpool to a friend or relative?

YesNo
Describe in 3 words what the Whirlpool brand means to you:
Please take a picture of your current appliance and upload it. If for example you would like to test a washing machine please photograph your current washing machine.
Upload Image

Upload a File

Cancelof

On a scale 1-10, How important are the features below when considering buying a new appliance?

On a scale of 1 - 10, How important are the following in your day to day life?