Store Name:

Store Type (circle all that apply):  Franchise  Independent  Retail   Rental

Store Address:

Date:

1. For rental stores only: Are ratings displayed visibly on the video/computer games?

yes  no  don't know

If yes, where are the ratings displayed?

On video case     On display case     On wall     On counter

Other:

2. Do you understand the Entertainment Software Rating Board (ESRB) rating system?

yes  no

3. Does your store in any way educate the public on the ESRB rating system?

yes    no    don't know

If yes, how? (Describe)

4. Does your store have any policy on training its employees on the ESRB rating system?

yes    no   don't know

If yes, please describe:

5. Does your store have a policy on children 12 or under buying games that are rated T or children under 17 buying games rated M?

yes    no    don't know

If yes, what is the policy?

If yes, how do you enforce the policy?