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.
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