Survey Subject: Sample
Survey
Number of Questions: 19
Payment for Completing This Survey: $25 US Dollars
1. Please supply us with
the following contact information:
Name:
Company or
Organisation:
Postal
Address:
City and
State:
Zip Code:
E-mail:
2. Do you currently use
any "Product Name will go here"?
Yes
No
I Don't know
3. What brand of
"Product" are you currently using presently?
Brand 1
Brand 2
Brand 3
Brand 4
Other
4. How did you buy this
"Product"?
Retail Store
Mall
Catalog
Web
Company
Other
5. Are there anyfeatures
this product does not have that you would specifically want out of a "Product"?
Yes
No
I don't know
6. What features does
your "Product" not have that you wish it did have?
7. How much money did
you pay for your "Product"?
8. How satisfied are you
with your "Product"?
Very Satisfied
Satisfied
Somewhat Dissatisfied
Very Dissatisfied
9. Out off the following
list of features, please select the top three that would be of most 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:
1.
2.
3.
11. Are there any
additional features that would be of specific importance to you?
Additional Feature 1
Additional Feature 2
Additional Feature 3
Additional Feature 4
Additional Feature 5
12. Are there any
particular features that a product must have for you to buy it? Please list what they are
in order of importance to you:
Essential Feature 1
Essential Feature 2
Essential Feature 3
Essential Feature 4
Essential Feature 5
13. How much money 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
willing to buy it? (0% = Not at all likely to buy it, 100% = Completely likely to buy)
15. How much are you
used to spending on new "products"?
16. What do you think
about the price of this "Product"?
Extremely Low
Somewhat Low
Just the right price
Somewhat High
Too High
17. Through what means
would you be the least likely to purchase this "Product"?
Retail
Direct Mail
Mail Order Catalog
Classified Advertisement
Telemarketer
18. What in your opinion
would be a good name for such a "Product"?
19. Can you please tell
us which one of the following possible product names you would like the most?
Product 1
Product 2
Product 3
Product 4
Product 5
Thank you for taking the
time to complete this survey. Click Submit to send your responses to us.