2017 Spring Picnic Marketbasket Survey
100%
Questions marked with an * are required Exit Survey
 
 
Thank you for your support of our Spring picnic survey program! Survey results are used for a national publicity campaign that reports the retail cost of food while emphasizing its relatively small increase in price over time compared to other consumer goods as well as the contribution of U.S. food, fiber and fuel production to national security.
 
 
 
Your Information
 
Contact Information
First Name *  : 
Last Name *  : 
Phone : 
Email Address : 
 
 
 
Store Information
 
 
City:
   
State: *
   
Zip Code:
   
Store Name:
   
Date Of Store Visit:
   
 
 
Shopping List
 
 
Red Delicious Apples
 
 
Price Per Pound:
   
 
 
 
Russet Potatoes (5 lbs.)
 
 
Price:
   
Size (if not a 5 lb. package):
   
 
 
 
American salad, 1 lb. (or Classic Iceberg)
 
 
Price:
   
Size (if not 1 lb.):
   
 
 
 
Orange juice (not from concentrate), 1/2 Gallon
 
 
Price:
   
Size (if not 1/2 Gallon):
   
 
 
 
Ground chuck, 1 lb. (Note: if not available, use 80-85 percent lean ground beef)
 
 
Price:
   
Size (if not 1 lb.):
   
 
 
 
Sirloin tip roast, 1 lb. (Also known as: Beef Round Tip Roast, Face Round Roast, Tip Sirloin Roast, Crescent Roast, Knuckle Roast, Round Roast, Ball Tip Roast, Cap Off Roast, Knuckle-Peeled Roast)
 
 
Price:
   
Size (if not 1 lb.):
   
 
 
 
Bacon, 1 lb.
 
 
Price:
   
Size (if not 1 lb.):
   
 
 
 
Sliced deli ham (lunch meat), 1 lb.
 
 
Price:
   
Size (if not 1 lb.):
   
 
 
 
Boneless chicken breast, 1 lb.
 
 
Price:
   
Size (if not 1 lb.):
   
 
 
 
Whole milk, gallon
 
 
Price:
   
Size (if not 1 Gallon):
   
 
 
 
Whole milk, 1/2 gallon (optional)
 
 
Price:
   
Size (if not 1/2 Gallon):
   
 
 
 
Organic milk, 1/2 gallon (optional)
 
 
Price:
   
Size (if not 1/2 Gallon):
   
 
 
 
Shredded mild cheddar cheese, 1 lb.
 
 
Price:
   
Size (if not 1 lb.):
   
 
 
 
Eggs, 1 doz. large, Grade A
 
 
Price:
   
Size (if not a dozen):
   
 
 
 
Eggs, 1 doz. large, cage-free (optional)
 
 
Price:
   
Size (if not one dozen):
   
 
 
 
All-purpose flour, 5 lbs.
 
 
Price:
   
Size (if not 5 lbs.):
   
 
 
 
Vegetable oil, 32 oz.
 
 
Price:
   
Size (if not a 32oz.):
   
 
 
 
Cheerios (toasted oats), 8.9-oz. box
 
 
Price:
   
Size (if not a 8.9 oz. box):
   
 
 
 
White bread, 20-oz. loaf
 
 
Price:
   
Size (if not a 20 oz. loaf):
   
 
 
 
Comments/Suggestions: