Sample Survey
Survey Topic: Sample
Number of Questions: 20
Payment for Completing Survey: $20 USD
1. Please supply us with your contact information:

Name: 

Organization: 

Address: 

City and State: 

  ZIP Code: 

E-mail: 
2. Do you currently use any "PRODUCT"?

Yes
No
Don't know
3. What brand of "PRODUCT" are you currently using?

Brand 1
Brand 2
Brand 3
Brand 4
Brand 5
Other
4. How did you purchase this "PRODUCT"?

Retail Store
Direct Mail
Catalog
Web
Company
Other
5. Are there features that this product does not have that you would want out of a "PRODUCT"?

Yes
No
Don't know
6. What features does your "PRODUCT" not have that you wish it did?

7. How much did you pay for your "PRODUCT"?

8. How satisfied are you with your "PRODUCT"?

Very Satisfied
Somewhat Satisfied
Somewhat Dissatisfied
Very Dissatisfied
9. Of the following list of features, please select the top three that would be of interest to you:

Feature 1
Feature 2
Feature 3
Feature 4
Feature 5
Feature 6
10. Of the three features you just listed, please rank them first, second and third in importance to you:

1.
2.
3.
11. Are there any additional features that would be of importance to you?

Additional Feature 1
Additional Feature 2
Additional Feature 3
Additional Feature 4
Additional Feature 5
12. Are there particular features that a product must have for you to purchase it? Please list what they are in order of importance:

Essential Feature 1
Essential Feature 2
Essential Feature 3
Essential Feature 4
Essential Feature 5
13. How much would you be willing to pay for a product with these features ("LIST FEATURES")?
14. If the "PRODUCT" was priced at (price) how likely, on a percentage basis, would you be to buy it?
(0% = Not at all likely to buy, 100% = Completely likely to buy)
15. How much are you authorized to spend on new products?
16. What do you think about the price of this "PRODUCT"?
Extremely Low
Somewhat Low
Just right
Somewhat High
Extremely High
17. Through what means would you be least likely to purchase this "PRODUCT"?
Retail
Direct Mail
Mail Order Catalog
Classified Advertisement
Telemarketer
18. Through what means would you be least likely to purchase this "PRODUCT"?

Retail
Direct Mail
Mail Order Catalog
Classified Advertisement
Telemarketer
19. What do you think would be a good name for such a "PRODUCT"?

20. Can you please tell us which one of the following possible product names you like the most?

Product 1
Product 2
Product 3
Product 4
Product 5
Thank you for taking the time to complete this survey. Select Submit Survey now to send your responses to us.