Let us know more about yourself for the best Retro Gamer Pack experience! Customer Information Survey Please fill in everything possible for the person receiving the pack so that they have the best experience possible! Store Order #: _____________ First Name: __________________________ Last Name: _______________________________ Phone #: ____________________________ Email: ___________________________________ Mailing Address: ____________________________________________________________________ What is your gender? What is your age? When is your birthday? Male Female __________ _____ / _____ (Day / Month) What is your shirt size? What is your foot length? (for socks!) XS S M L XL 2XL ____________ inches What is your favourite colour? What kind of retro gamer / collector are you? Total Newbie, I just like playing Hardcore collector! ____________________ but looks fun. them! Any food allergies? (Please list all that would be a concern.) ____________________________________________________________________________ Which of the following retro gaming consoles do you CURRENTLY own? Take your time! Be specific! Check the exact consoles you have now so we know what carts or discs we can send. Otherwise you may not be able to play them when they arrive! Next page, you can list systems you are interested in collecting in the future. NES Super NES Nintendo 64 GameCube Master System Genesis Saturn Dreamcast Game Boy Game Boy Color GBA Game Gear PlayStation PlayStation 2 Xbox PSP Atari 2600 ColecoVision Intellivision Other __________________ Imports Acceptable? (check any if acceptable) Homebrew? (new & re-licenced) Japanese European PAL format Yes No On this page we get to know a little bit more about your personal tastes in retro gaming. Let us know what game systems you are interested in, what types of games you enjoy most and what kind of themes appeal to you. The consoles you pick are the ones we will send you games from! You will need to own a system that can play games of that platform. We will do our very best to match up your pack to your own personal tastes to make it the best experience we can for you. Try to give us as much information as you can about what you like. There is also a notes section to tell us anything you feel we didn’t ask you. Grey text indicates that the console is not available from the Retro Gamer Pack! We ask that you pick at least 2 in black text. Which of the following retro gaming consoles are you INTERESTED in? (min. of 2!) NES Super NES Nintendo 64 GameCube Master System Genesis Saturn Dreamcast Game Boy Game Boy Color GBA Game Gear PlayStation PlayStation 2 Xbox PSP Atari 2600 ColecoVision Intellivision Black = available Grey = unavailable What types of game genre do you most enjoy? (pick 4 minimum) Platformer RPG Fighting Pinball Vehicle Sim Run & Gun Scrolling Shooter FPS Sports Light Gun Party Game Racing Board Game Game Show Educational Classic Arcade Beat ‘em Up Action Strategy Music / Rhythm Puzzle God / Economy Sim RTS Stealth Adventure What types of game themes do you most enjoy? (all that apply) Superheroes Martial Arts Military Cartoons Colonial Japanese Anime Movie / TV Show Science Fiction Fantasy Pirates / Navy Wrestling Robots / Mecha Dark / Moody Kids Games Mystery Horror Abstract / Surreal Wild West Crime / Mafia Mythology Notes & extra information: Bonus Info: The information you provide on this sheet is not necessary unless you have franchise specific preferences. It will further aid us in choosing between characters, franchises & other minor selections. It is meant to further enhance your experience, however you may choose to skip this page altogether. Which of these retro game characters / groups are you a fan? (pick all that apply) Super Mario Bros. Sonic the Hedgehog Ninja Turtles Mega Man Master Higgins Marvel Superheroes DC Superheroes Billy & Jimmy Kirby Pac-Man Disney Characters Street Fighter Fighters Q*bert Dig-Dug Donkey Kong Samus Aran Final Fantasy Creatures Zelda Battletoads Dragon Quest Monsters Mortal Kombat Fighters The Simpsons Pokémon Link The Belmont Family Solid Snake Bub & Bob Bonk Wonder Boy Earthworm Jim Fox McCloud (Star Fox) Ryu Hayabusa (Ninja Gaiden) Shinobi Lemmings Bomberman Frogger Crash Bandicoot Toejam & Earl Alex Kidd The Lost Vikings Power Rangers Ghostbusters Robocop Space Invaders Bionic Commando Bill & Lance (Contra) Laura Croft (Tomb Raider) Rambo Bucky O’Hare Looney Tunes Characters What are your top 4 favourite game franchises? ____________________ ____________________ ____________________ ____________________ What are your top 4 favourite game developers/publishers? ____________________ ____________________ ____________________ ____________________ Do you have any these accessories? (check all that apply) NES Zapper NES Max NES Advantage NES Four Score Light Phaser (SMS) Power Glove SNES Mouse Super Scope Super Advantage (SNES) NES Satellite Super Multitap (SNES) Team Player / 4 Way Play (Genesis) Game Genie (NES) R.O.B. (NES) Game Genie (Genesis) Game Genie (Game Boy) Rumble Pack (N64) Guitar (PS2) Game Genie (Game Gear) Genesis Mouse Transfer Pak (N64) Microphone (N64) Enforcer Gun (Genesis) Enforcer Gun (SNES) Driving Wheel (PS2) Driving Wheel (Xbox) Multitap (PS1/2) 4-Player Adaptor (Game Boy) Game Link Cable (Game Boy) Super Game Boy (SNES) What means of video connection do you currently use? (List any you use right now!) Composite AV (Yellow RCA) Component (Green/Blue/Red RCA) HDMI S-Video RF (Coax) VGA Unsure Do you have a working CRT (aka “tube”) TV? Yes No.