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? None Vision Impaired Hearing Impaired Mobility Challenges 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? Yes No Have access to a vehicle 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? Male 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? £10-£30 £30-£60 £60-£100 £100-£150 £150-£200 £200+ 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